Enteral hydrolyzed formula enhances preoperative bowel preparation in children with hirschsprung’s disease: a prospective andrandomized study

Abstract

Objective To determine the effect of enteral hydrolyzed formula for preoperative bowel preparation in children with hirschsprung disease (HD). Methods Between December 2014 and February 2018, a total of 187 rectal-sigmoid HD patients underwent lapraroscopic Soave’s pull-through surgery in our institution were enrolled into three groups: Group A (n=68) received an enteral nutrition which is a kind of enteral hydrolyzed formula, group B (n=62) received routine diet for preoperative bowel preparation and gourp C (n=57) received total parenteral nutrition, during bowel preparation which began at least 10 days before surgery. The time of preoperative bowel preparation and intestinal cleanliness during surgery and various physiological indications before and after surgery were measured. Results The mean time of preoperative bowel preparation is (4.52±1.22), (7.42±1.85) and (2.85±0.70) days, respectively, in group A, B and C. No significant difference in the quality of colon cleansing during surgery between group A and C, and both higher than group B (P=0.001, respectively). Thirteen patients in group B had a slight decrease in serum prealbumin levels. In group C, 9 patients showed the increased level of serum alanine aminotransferase (ALT), aspartate aminotransferase (AST). The mean time to first flatus postoperatively in group C was significantly longer than group A and B (3.21 d versus 0.93, 2.42 d, respectively, P=0.001). No significant difference in the occurrence of incision infection and anastomotic leakage postoperatively between three groups. The follow-up period was 1 month. The incidence of hirschsprung associated enterocolitis (HAEC) in group C was higher than group A and B, respectively (19.30% versus 8.82%, 9.68%, respectively, P=0.001). The length of hospital stay in group C was longer than group A and B, respectively (10.12 d versus 7.61, 8.33 d, respectively, P=0.013). Conclusion Enteral hydrolyzed formula as a nutrition support could facilitate the process of preoperative bowel preparation in HD patients; it can significantly reduce the time of preoperative bowel preparation and enhance recovery after surgery, with a significant reduction in length of hospital stay and incidence of HAEC. Key words: Hirschsprung disease; Enteral hydrolyzed formula; Preoperative bowel preparation; Laparoscopy; Pull-through