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Rectal irrigations for the prevention of postoperative enterocolitis in Hirschsprung's disease
T L Marty1, T Seo, J J Sullivan
1University of Utah, Primary Children's Medical Center, Salt Lake City 84113-1100, USA.
Insights
Routine rectal irrigations significantly reduced postoperative enterocolitis in children with Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Medicine
Background:
- Hirschsprung's disease is a congenital condition requiring surgical correction.
- Postoperative enterocolitis is a serious complication following surgery for Hirschsprung's disease.
- Previous mortality from enterocolitis highlights the need for preventative strategies.
Purpose of the Study:
- To evaluate the efficacy of routine postoperative rectal irrigations in preventing enterocolitis in pediatric patients with Hirschsprung's disease.
- To assess the impact of rectal irrigations on the incidence and severity of postoperative enterocolitis.
Main Methods:
- A retrospective review of 135 pediatric patients who underwent surgical treatment for Hirschsprung's disease over 22 years.
- Comparison of outcomes between 40 patients receiving routine postoperative rectal irrigations and 95 historical controls not receiving irrigations.
- Rectal irrigations with normal saline were administered twice daily for 3 months, then once daily for 3 months, starting 1-2 weeks postoperatively.
Main Results:
- A significant reduction in the incidence of postoperative enterocolitis was observed in the rectal irrigation group (3 of 40) compared to the non-irrigation cohort (34 of 95).
- Statistical analysis using Fisher's exact test showed a P < .001, indicating a highly significant difference.
- No complications were reported directly resulting from the rectal irrigation procedure itself.
Conclusions:
- Routine postoperative rectal irrigations are an effective method for decreasing the incidence and severity of enterocolitis in children after surgical correction of Hirschsprung's disease.
- This intervention appears to be safe and well-tolerated by pediatric patients.
- The findings support the integration of routine rectal irrigations into postoperative care protocols for Hirschsprung's disease.
Abstract:
The purpose of this clinical trial was to examine the role of rectal irrigations in the prevention of postoperative enterocolitis in children with Hirschsprung's disease. Over the past 22 years 177 children had surgical treatment for Hirschsprung's disease at a single pediatric hospital. Five children have died of other causes. Of the remaining 172 patients, follow-up clinical information was obtained from 135 (78%). In 1989, all of the children undergoing surgical reconstruction for Hirschsprung's disease were placed on routine postoperative rectal irrigations with normal saline. The parents were instructed in the irrigation technique before leaving the hospital. Irrigations were started 1 to 2 weeks postoperatively and were performed two times a day for 3 months, then once a day for an additional 3 months. There were no complications from the irrigations themselves. A previous report from the authors' institution has documented five sudden deaths over the past 22 years from fulminant postoperative enterocolitis. These five children all had an unremarkable postoperative recovery, then developed a rapidly progressive diarrheal illness. All of these deaths occurred before the institution of routine postoperative irrigations. Of the 135 patients in this review, 40 had the postoperative rectal irrigations. The remaining 95 children serve as historical controls. Data analysis showed that 34 of the 95 children in the nonirrigation cohort developed postoperative enterocolitis compared with 3 of 40 in the rectal irrigation cohort; P < .001 using Fisher's exact test. In the authors' experience, routine postoperative rectal irrigations have significantly decreased the incidence and severity of enterocolitis in children after surgical correction of Hirschsprung's disease.