Abstract
BackgroundSince the length of the affected colon widely varies, the preoperative management of Hirschsprung’s disease varies from one hospital to another. For our cases in which the length of the aganglionic colon cannot be managed by enema, anal bougienage, or rectal irrigation, colorectal irrigation is used along with the placement of a transanal catheter for these patients as home or hospital management, until one-stage definitive surgery can be performed. No comparative studies have been conducted on the continuous tube placement method, and no study has utilized this method as home management. Thus, this study aimed to analyze the efficacy and feasibility of our proposed continuous tube placement management for patients with Hirschsprung’s disease in the hospital or even at home.ResultsWe included 22 infants with Hirschsprung’s disease between 2008 and 2018. The patients were divided into two groups: those who were managed with enema, bougienage, and rectal irrigation (n = 6), and those who were managed with the placement of a continuous transanal tube and colorectal irrigation (n = 16). The group with continuous transanal tube placement was further divided into two groups: those who were preoperatively managed with a continuous anorectal tube at home (n = 7), and those at a hospital (n = 9). Preoperative demographic information and clinical details were retrospectively examined and compared between the two groups. Univariate analysis showed no significant differences in the backgrounds and clinical status between the enema, bougienage, and rectal irrigation group and the colorectal irrigation group. The patients in the home group were older and weighed more at the time of radical surgery than those in the hospital group (p = 0.0267, p = 0.0377, respectively). The total duration of hospitalization until radical surgery was significantly decreased in the home group (p = 0.0315).ConclusionsThe total duration of hospitalization was significantly reduced in patients undergoing home colorectal irrigation which was as effective as the conventional method, with no impact on the preoperative condition or postoperative outcomes. Hence, our home-based preoperative management for patients with Hirschsprung’s disease may be effective and potentially feasible for the management of patients with Hirschsprung’s disease.
Highlights
Since the length of the affected colon widely varies, the preoperative management of Hirschsprung’s disease varies from one hospital to another
22 patients were included in our study; they were divided into the following two groups: those who were managed with conventional methods (n = 6), and those who were managed with the placement of a continuous transanal tube and colorectal irrigation (n = 16)
The univariate analysis revealed no significant differences in the preoperative status with respect to sex, gestational age, birth weight, age at diagnosis, type of Hirschsprung’s disease (HD), preoperative enterocolitis, and other complications between the home colorectal irrigation (HCI) and non-HCI groups
Summary
Since the length of the affected colon widely varies, the preoperative management of Hirschsprung’s disease varies from one hospital to another. For our cases in which the length of the aganglionic colon cannot be managed by enema, anal bougienage, or rectal irrigation, colorectal irrigation is used along with the placement of a transanal catheter for these patients as home or hospital management, until one-stage definitive surgery can be performed. This study aimed to analyze the efficacy and feasibility of our proposed continuous tube placement management for patients with Hirschsprung’s disease in the hospital or even at home. To prevent the development of complications after this one-stage definitive operation, appropriate preoperative management with enemas, anal bougienage, and rectal irrigations is required, instead of ostomy. Mochizuki et al reported that this procedure was safe and effective even for long- and total-type HD [5] This method enables intestinal decompression for a relatively long period; the radical surgery can be made semielectively. We evaluated the feasibility of this continuous tube placement for HD by comparing with other methods of preoperative management
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