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Early intervention in Hirschsprung's disease: effects on enterocolitis and surgical outcomes
Yunhan Zhang1, Xiao Xiang1, Xunfeng Li1
1Department of neonatal surgery, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Structural Birth Defect and Reconstruction, Children's Hospital of Chongqing Medical University, Chongqing, China.
Insights
Early surgery for Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Outcomes Research
Background:
- Hirschsprung's disease (HSCR) management involves debated surgical timing.
- Evaluating surgical age's impact on midterm outcomes is crucial.
Purpose of the Study:
- To assess the correlation between age at surgery and midterm outcomes in HSCR patients.
- To compare anal function and quality of life based on surgical timing.
Main Methods:
- Retrospective analysis of 235 HSCR patients (2015-2019).
- Stratification into two groups: surgery <3 months vs. 3-12 months.
- Comparison of complications, anal function (Rintala scale), and quality of life (PedsQLTM4.0).
Main Results:
- No significant differences in postoperative bowel function or quality of life between groups.
- Significantly lower incidence of Hirschsprung-associated enterocolitis (HAEC) in the <3 months group (69.1% vs. 30.9%).
Conclusions:
- Surgical age does not significantly affect mid-term anal function or quality of life in HSCR.
- Early intervention (<3 months) reduces HAEC incidence, minimizes bowel resection, and shortens surgery duration.
Background:
The timing of surgical intervention for Hirschsprung's disease (HSCR) has been a topic of continued discussion. The objective of this study was to evaluate the significance of age at surgery in the management of HSCR by conducting a comparative analysis of the correlation between surgical age and midterm outcomes.
Methods:
We conducted a retrospective analysis of children with HSCR who underwent one-stage laparoscopic assisted pull-through surgery with modified Swenson technology at our hospital between 2015 and 2019. The study population was stratified into two groups based on surgical age: patients who underwent surgery within a period of less than 3 months and those who underwent surgery between 3 and 12 months. The basic conditions, complications at 3-7 years after surgery, anal function (Rintala scale) and quality of life (PedsQLTM4.0) were compared between the groups.
Results:
A total of 235 children (196 males and 39 females) were included in the study. No statistically significant differences in postoperative bowel function (P = 0.968) or quality of life (P = 0.32) were found between the two groups. However, there was a significant reduction in the incidence of Hirschsprung-associated enterocolitis (HAEC) among individuals under the age of three months prior to undergoing surgical intervention (69.1%) compared to the incidence observed postsurgery (30.9%). This difference was statistically significant (P < 0.001).
Conclusion:
In the current study, the age at which surgery was performed did not exhibit a discernible inclination towards influencing mid-term anal function or quality of life. Early surgical intervention can effectively diminish the occurrence of HAEC, minimize the extent of bowel resection, and expedite the duration of the surgical procedure.
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