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For short-segment Hirschsprung disease, daily trans-anal irrigation before pull-through surgery is necessary?

Hang Lu1, Jie Tang1, Changgui Lu1

  • 1Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.

Pediatric Research
|November 16, 2024
PubMed

Insights

Daily trans-anal irrigation (TAI) before surgery for Hirschsprung disease (HSCR) did not significantly prevent enterocolitis (HAEC) or improve outcomes. This study suggests that frequent TAI may not be necessary for children with HSCR undergoing pull-through surgery.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Clinical Outcomes Research

Background:

  • Hirschsprung disease-associated enterocolitis (HAEC) is a serious complication following pull-through surgery for short-segment Hirschsprung disease (HSCR).
  • Trans-anal irrigation (TAI) is a therapeutic option explored to mitigate HAEC and improve surgical outcomes.

Purpose of the Study:

  • To evaluate the efficacy of daily trans-anal irrigation (TAI) administered preoperatively in preventing HAEC.
  • To assess the impact of daily TAI on other clinical outcomes, including nutritional status, postoperative recovery, and long-term defecation function in children with short-segment HSCR.

Main Methods:

  • A cohort study comparing children with short-segment HSCR who underwent pull-through surgery.
  • Two groups were analyzed: one receiving daily TAI preoperatively and a control group receiving non-daily TAI (anal dilation or glycerine enema).
  • Propensity score matching was used to control for confounding variables, with HAEC incidence, nutritional status, and functional outcomes compared.

Main Results:

  • A total of 191 children were initially enrolled, with 88 children (44 pairs) matched for analysis.
  • The incidence of HAEC was similar between the daily TAI group (11.36%) and the non-daily TAI group (11.36%), with no statistically significant difference (p=1.000).
  • No significant differences were observed in nutritional status at surgery, postoperative rehabilitation indicators, or long-term defecation function between the two groups.

Conclusions:

  • Preoperative daily trans-anal irrigation (TAI) does not offer a significant advantage over non-daily TAI in preventing Hirschsprung disease-associated enterocolitis (HAEC).
  • Daily TAI before pull-through surgery does not appear to improve postoperative recovery or long-term defecation function in children with short-segment Hirschsprung disease.
  • The routine use of daily TAI in the preoperative period for short-segment HSCR may not be clinically necessary.
Abstract

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