Abstract
PurposeHirschsprung’s disease (HSCR) is a developmental defect of the enteric nervous system. Transanal endorectal pullthrough (TERPT) is one of the surgical procedures for HSCR. Clavien–Dindo is an objective classification system, used worldwide, to describe postoperative complications. The aim of this study was to use Clavien–Dindo grading for short-term complication after TERPT.MethodsThis was a cohort study including all 69 individuals, with biopsy-verified HSCR, managed with TERPT at our institution between 2006 and 2018. Data on the surgical procedure, as well as short-term complications, were retrieved from the medical records. The main outcome was postoperative complications graded according to Clavien–Dindo.ResultsFifteen (22%) of the 69 patients (51 males) had a short-term postoperative complication graded according to Clavien–Dindo. The complications were Grade I in ten patients, Grade II in four patients, and Grade IIIb in one patient. Individuals with a Clavien–Dindo complication had a significantly longer post-operative hospital stay [median 6 days (4–30) compared to 4 days (1–22), p = 0.035].ConclusionsIt is important to describe postoperative complications in a structured way to make it possible to compare studies. Post-operative complications, according to Clavien–Dindo, occurred in 22% of the patients after TERPT.
Highlights
Hirschsprung’s disease (HSCR) is a congenital malformation, characterized by the absence of ganglion cells in the distal hindgut
Retrospective grading according to Clavien–Dindo was performed for each case as well as every type of complication that was registered
Associated malformations were found in nine patients (13%)
Summary
Hirschsprung’s disease (HSCR) is a congenital malformation, characterized by the absence of ganglion cells in the distal hindgut. Modifications of this technique are frequently used today [2]. Anastomotic stricture, postoperative Hirschsprung-associated enterocolitis (HAEC), wound infections, bleeding, and perianal excoriations are other early post-operative complications [3, 4]. To be able to compare post-operative outcomes between different surgical centres, there is a need for an objective grading system of the early complications. Clavien–Dindo is a grading system used to objectively and reproducibly classify postoperative complications [5]. It consists of seven grades with increasing severity. Grade I being the most benign, stating that any deviation from the normal postoperative course without pharmacological treatment or surgical, endoscopic, and radiological interventions and Grade V is death (Table 1)
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