Incidence Of Postoperative Enterocolitis Research Articles

Clinical Efficacy of an Indwelling Transanal Tube for the Prevention of Anastomotic Leakage After Hirschsprung's Disease: A Single Center Experience with Chinese Patients.

Background: The aim of this study was to investigate the clinical effectiveness of an indwelling transanal tube for the prevention of anastomotic leakage (AL) after a radical operation for Hirschsprung's disease (HD). Methods: We retrospectively analyzed the clinical data from 158 patients who had undergone laparoscopic-assisted Soave procedures for HD at our hospital from May 2015 to May 2019. Patients were divided into two groups depending upon whether the anal drainage tube was retained or not retained: an indwelling group (group A, n = 86) and a no-indwelling group (group B, n = 72). Results: All 158 children had a successful operation by a laparoscopic technique. There was no significant difference in the duration of the operation, the length of the incision, the amount of bleeding, or the postoperative hospitalization time between the two groups. Compared with the no-indwelling group, maintaining the transanal tube had significant advantages for preventing incidences of AL (P < .05). The 4-year follow-up showed that the incidence of postoperative enterocolitis with the indwelling transanal tube was significantly lower than in the group without the drainage tube (P < .05). Conclusions: The laparoscopic-assisted Soave procedure with an indwelling transanal tube is a safe and feasible method for the treatment of HD in children. This method can not only drain intestinal contents but also reduce the occurrence of AL.

Transanal endorectal pull-through procedure versus transabdominal surgery for Hirschsprung disease

Objective:To analyze the clinical results of transanal endorectal pull-through (TERPT) and transabdominal approach (TAB) in the treatment of Hirschsprung disease.Methods:We searched all publications in the PubMed, MEDLINE, EMBASE, and Cochrane library databases between January 2003 and November 2018. The study included randomized controlled trials (RCTs) and observational clinical studies (OCSs), to compare the surgery duration, length of postoperative hospital stay, incidence of postoperative incontinence/soiling, constipation, and enterocolitis between the TERPT and TAB groups. Mantel-Haenszel method was used for continuous variables, the combined odds ratios (ORs) and 95% confidence intervals (CIs) for dichotomous variables were used.Results:In the 87 studies, we include 1 case of RCTs and 9 cases of OCSs. Including 392 cases of TERPT and 332 cases of TAB groups. TERPT has a short postoperative hospitalization [mean difference (MD) = −6.74 day; 95% CIs; −13.26 to −0.23; P = .04], and a low incidence of postoperative incontinence (ORs = 0.54; 95% CIs, 0.35–0.83; P = .006) and constipation (ORs = 0.50; 95% CIs, 0.28–0.90; P = .02). There was no difference in duration of surgery (MD = −30.59 min; 95% CIs, −98.01–36.83; P = .37) and incidence of postoperative enterocolitis (ORs = 0.78; 95% CIs, 0.53–1.17; P = .23).Conclusion:TERPT is superior to TAB in terms of hospitalization time, postoperative incontinence, and constipation. However, there are still a large number of RCTs to verify, and more trials are expected to be testified in the future.

Laparoscopic Duhamel Procedure with Ex-Anal Rectal Transection for Right-Sided Hirschsprung's Disease.

Increased defecation frequency and soiling are common complications of surgery for right-sided Hirschsprung's disease (HD). Though the laparoscopic Duhamel procedure is a favorable option in right-sided HD, the conventional laparoscopic technique is time consuming and has complications that are associated with the reservoir. In this study, we described a modified laparoscopic Duhamel technique with ex-anal rectal transection combined with the Deloyer's procedure for right-sided HD. Between March 2010 and January 2015, 18 right-sided HD underwent this modified laparoscopic Duhamel procedure (MLDP). The main modifications were to mobilize the colon and to dissect the retrorectal space under laparoscopy, pull out, and transect ex-anally by using a linear stapling device through a transverse incision on posterior wall of the rectum. Seven age-matched patients who underwent a conventional laparoscopic Duhamel procedure (CLDP) between March 2008 and December 2010 were included as the control group. Demographics, surgical procedures, operative data, postoperative complications, and clinical outcomes were compared between these two groups. Operative time was significantly shorter in the MLDP group (150 minutes versus 195 minutes; P = .03). There was no significant difference in mean timespan to obtain a normal defecation frequency (3.8 months versus 3.6 months), incidence of soiling (11.1% versus 14.3%; P = .34), and constipation (5.6% versus 14.3%; P = .69). Pouchitis were not found in the MLDP group, whereas 2 patients in the CLDP group (28.6%) presented with pouchitis and intractable diarrhea, requiring spur division. The incidence of postoperative enterocolitis was not significantly different in the two groups (11.1% in MLDP versus 14.3% in CLDP; P = .68). All 22 patients had a normal defecation over 4 years of age. Laparoscopic Duhamel with ex-anal rectal transection is a simple, easy-to-learn, and effective procedure for right-sided HD. It has low postoperative pouchitis because of a short pouch.

Quality of life and parents’ satisfaction with Duhamel’s versus transanal endorectal pull-through for the treatment of Hirschsprung’s disease in children

Background The aim of this study is to compare the surgical outcome as well as parents’ satisfaction and quality of life for children after the transanal and the Duhamel pull-through operations in a single-center experience. Patients and methods A retrospective cohort file review was carried out of all cases of Hirschsprung’s disease treated surgically in our institution. Patients were classified into group 1 (transanal endorectal pull-through) and group 2 (Duhamel pull-through). Three questionnaires were designed. Demographic data, perioperative data, complications, and the length of follow-up data were analyzed statistically. Results Six-nine patients were included. Medications were required postoperatively in 27% of the patients in group 1 versus 60.7% of patients in group 2. In group 1, 22.5% of parents were fairly satisfied and 69% of parents were satisfied, whereas in group 2, 31.8% of parents were poorly satisfied, 40.9% were fairly satisfied, and 27.3% were satisfied. Patients were older than 3 years; no patients had poor results in group 1 versus 33.3% in group 2. Conclusion Our experience with transanal pull-through showed less incidence of postoperative enterocolitis, failure to thrive, redo surgery, and need for anticonstipation medications than that with Duhamel pull-through. Although the anorectal scoring system showed better results in transanal pull-through than Duhamel pull-through in all age groups, it was statistically significant in patients older than 3 years of age. There was a statistically significantly better parent satisfaction and quality of life in the transanal group than the Duhamel pull-through group. Keywords : Hirschsprung’s disease, parent satisfaction, quality of life and children

Patterns of postoperative enterocolitis in children with Hirschsprung's disease combined with hypoganglionosis

Objective The relationship between postoperative enterocolitis (EC) and Hirschsprung's disease (HD) combined with hypoganglionosis (HYP) has not been thoroughly reported elsewhere. The aim of this study was to investigate the incidence of EC after operation in children with HD combined with HYP and to identify new strategies to prevent postoperative EC. Methods From 1998 to 2005, 97 children with HD underwent the modified Swenson's procedure in this institute. They were classified into 2 groups based on pathologic investigation as follows: group A contained 70 patients with HD and group B contained 27 patients with HD complicated with HYP. The mean follow-up time from the time of the operation was 3.4 years (range, 1.5-8 years). The incidence of postoperative EC and anorectal functions were evaluated and compared between these 2 groups. Results Eight cases (11.4%) in group A developed postoperative EC, whereas 11 (40.7%) in group B did so. The incidence of postoperative EC in group A was significantly lower than that in group B ( P < .005). According to the Rintala scoring system, the percentage of patients with an excellent score in group A (85.7%) was significantly higher than that in group B ( P < .05). The recurrence rate of constipation in group B was 14.8% (4/27), whereas it was 2.8% (2/70) in group A. Conclusions Postoperative EC is associated with retained proximal HYP, which suggests that HYP could be, at minimum, a predictive marker for this complication. Complete resection of HYP segment could potentially minimize the incidence of postoperative EC and alleviate the severity of EC.

Personal Experience with 50 Laparoscopic Procedures for Hirschsprung's Disease in Infants and Children

Purpose: To report experience with minimally invasive surgery for Hirschsprung's disease (HD) in infants and children. Patients and Methods: A total of 50 procedures were performed in various pediatric centers. Both primary and assisted pull-throughs were carried out. The personal data and anatomy were typical for children with HD. Results: Operative time for the 44 primary pull-through procedures averaged 140 minutes. Two patients required open conversion for anatomic reasons. No intraoperative or postoperative complications were encountered. Prompt recovery and excellent early and intermediate-term results were noted. There seemed to be marked reductions in the incidence of postoperative enterocolitis and anastomotic strictures in these babies. Conclusions: Laparoscopic pull-through for HD is easy to learn and to perform. The patients recover faster and with fewer complications than after the classic open operations. Indeed, this laparoscopic procedure should become the new gold standard for the treatme...

Management of Hirschsprung's disease with reference to one-stage pull-through without colostomy

Background/Purpose: The authors evaluated the safety and benefits of 1-stage pull-through in comparison with staged repair of Hirschsprung's disease under circumstances prevailing in a developing country. Methods: Forty-nine patients were treated for Hirschsprung's disease during a 7-year period between January 1991 and March 1998 at our institution, which is a tertiary referral center. Nine patients were excluded from the study, and the medical records of the remaining 40 patients were reviewed. Results: Eighteen patients including 7 neonates underwent 1-stage pull-through, and 22 patients underwent staged correction. There was no mortality for patients undergoing one-stage treatment, but there was 1 death caused by anastamotic leak after a 2-stage repair. There was no substantial difference in the incidence of complications (38.8% v 45.45%) and the need for additional surgical procedures (33.5% v 45.45%) between the 2 groups. Seventy-one percent after 1-stage treatment and 80% after staged treatment had a satisfactory functional result, and the incidence of incontinence was 14% and 10%, respectively. Overall, the incidence of postoperative enterocolitis was low (7.5%). Conclusions: One-stage correction of Hirschsprung's disease is a safe procedure in all age groups. It offers economical and social advantages to families in developing countries. Benefits of 1-stage treatment include avoidance of multiple operations, elimination of complications associated with a colostomy, shorter duration of hospital stay, and completion of treatment at an earlier age. It is advisable to continue postoperative anal dilatation for a minimum period of 6 months to 1 year to reduce the incidence of enterocolitis.

Modified soave pull-through for Hirschsprung's disease: Intraoperative internal sphincterotomy

Background/Purpose: Anorectal achalasia (AA) may persist after pull-through (PT) for Hirschsprung's disease (HD), which may cause postoperative enterocolitis (POE) and constipation. The authors modified the Soave PT (modified Soave PT, MSPT) to eliminate AA, and present their results. Methods: This was a 16-year retrospective review of 43 patients with histologically proven HD of the rectosigmoid or sigmoid colon treated by MSPT. The MSPT ivolves excision of the posterior rectal cuff and an intraoperative internal sphincterotomy, allowing the PT colon to fit nicely. Results: Mean age at MSPT was 16.7 months (16 were ≤3 months old [37%]; 7 were neonates [16%]). Mean follow-up was 9.2 years. Six of 43 cases (14%) had preoperative enterocolitis; only 2 of 43 (5%) had single episodes of POE. At review, 37 of 43 were older than 4 years; 29 (78%) had normal bowel function (14 had experienced soiling after MSPT, which resolved after a mean of 6.4 years); and 8 (21%) had problematic bowel function: 3 had occasional soiling, 1 had soiling only before defecation, 3 (8%) had constipation requiring laxatives or enemas, and 1 had significant soiling. Conclusion: MSPT is safe and may contribute to a reduction in the incidence of POE and constipation.

Enterocolitis after the surgical treatment of Hirschsprung's disease: Risk factors and financial impact

Background/Purpose: Enterocolitis (EC) represents a serious complication after the surgical correction of Hirschsprung's disease (HD). Although previous studies have identified risk factors associated with the development of this complication before definitive repair, the factors leading to EC after pull-through have not been examined. This study was therefore designed to determine risk factors for the development of post-pull-through EC. Methods: Patients with HD treated from 1991 through 1996 at the Hospital for Sick Children in Toronto, Canada were assessed. Risk factors were examined in three areas: patient factors (gender, age at diagnosis, age and weight at pull-through), technical factors (type of repair, number of stages, location of transition zone, previous EC), and mechanical factors. Results: In 105 consecutive patients, the incidence of postoperative EC was 32%. There was no mortality. The risk of postoperative EC was significantly increased by mechanical factors related to anastomotic complications (relative risk, 2.8) and intestinal obstruction (relative risk, 3.5). This finding was not attributable to the general occurrence of any postoperative complication because the incidence of postoperative complications was equally distributed in patients with and without EC. The presence of EC significantly increased the number of hospital admissions, mean length of stay, and total treatment cost. Conclusion: These findings suggest the use of measures to decrease mechanical obstruction so as to decrease the incidence and impact of this potentially devastating complication.

Kasai's rectoplasty in the treatment of Hirschsprung's disease and other types of colorectal dysganglionosis in children

Kasai's colo(ileo)rectoplasty with posterior triangular colonic flap was performed in 94 children (28 girls and 66 boys). In cases of total colonic aganglionosis Kasai's procedure was modified by Martin's extended side-to-side anastomosis. Aganglionosis (Hirschsprung's disease, HD) was found in 54 cases, HD associated with neuronal intestinal dysplasia (NID) in 26, hypoganglionosis (HG) in 5, HG and NID in 5, and NID in 4. A one-stage procedure was performed in 39 children; in 55 a preliminary enterostomy was carried out. Colo(ileo)rectoplasty without a simultaneous enterostomy was done in 85 children. Wound complications were observed in 18 cases (19.1%): infection in 12 and disruption in 6. Anastomotic leaks occurred in 11 cases (11.7%); subsequent diversion was inevitable in 6. In 10 children (10.6%) the anastomotic stricture was relieved by dilatation. Subsequent sphincteromyectomy of the internal anal sphincter because of constipation was performed in 8 children. Postoperative enterocolitis was observed in 3 cases (3.1%), in 2 of them due to residual dysganglionic colon. There was no mortality in our series. Kasai's procedure compares favorably with other interventions; its advantage is the low incidence of postoperative enterocolitis, however, the intended relief of chronic constipation may fail to occur. To relieve chronic constipation a larger sphincteromyectomy and greater resection of the rectal wall are necessary.

Enterocolitis in Hirschsprung's disease

During the 5 years 1985–1989, 24 (32%) of 76 patients treated for Hirschsprung's disease (HD) developed enterocolitis, this being present at the time of diagnosis in 10 (13%) infants, 7 of whom were neonates. HD presented as necrotizing enterocolitis in 5 neonates, 4 of whom were premature. The enterocolitis developed postoperatively in 14 (18%) patients, in 7 after an enterostomy and in 7 after a pull-through procedure. Recurrent episodes of enterocolitis occurred in 4 of the patients who developed postoperative enterocolitis. The risk of enterocolitis was increased in girls, in patients with associated Down's syndrome, those with a family history of HD, and those managed by an endorectal pull-through procedure. The Duhamel procedure was associated with a low (5%) incidence of postoperative enterocolitis. Long-segment aganglionosis was not associated with an increased risk of enterocolitis and preoperative enterocolitis conferred no increased risk of postoperative enterocolitis.