Postoperative rectal irrigation after laparoscopic Swenson pull-through: is early instrumentation safe?

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Surgical Innovation

Background:

• Laparoscopic Swenson endorectal pull-through (Lap-S-ERPT) for Hirschsprung disease (HSCR) may cause early obstructive symptoms due to less dissection.
• Rectal instrumentation is a concern with low anal anastomosis post-Lap-S-ERPT.
• Current management relies on antibiotics and rectal irrigations.

Purpose of the Study:

• To assess the incidence and safety of early rectal irrigations following Lap-S-ERPT in pediatric HSCR patients.
• To evaluate the impact of rectal irrigations on anastomotic leak rates.

Main Methods:

• Single-center retrospective review of 37 pediatric patients undergoing Lap-S-ERPT for HSCR (Jan 2018-Oct 2023).
• Rectal irrigations were administered for obstructive symptoms (emesis, obstipation, dilated colon).
• Primary outcome: need for postoperative rectal irrigation; Secondary outcomes: timing, duration, and anastomotic leak incidence.

Main Results:

• 11 out of 37 patients (29.7%) received rectal irrigations, initiated at a median of 46 hours post-surgery.
• Irrigations lasted a median of 3 days.
• No significant difference in anastomotic leak rates between irrigated and non-irrigated groups (9.1% vs. 7.7%, p=0.887).

Conclusions:

• Nearly 30% of pediatric patients required early rectal irrigations post-Lap-S-ERPT for obstructive symptoms.
• Rectal irrigations were safely administered without increasing anastomotic leak rates, despite concerns regarding low anastomosis.