Background: The incidence of Hirschsprung disease (HSCR) is nearly 1/5000 and patients with HSCR are usually treated through surgical intervention. Hirschsprung disease-associated enterocolitis (HAEC) is a complication of HSCR with the highest morbidity and mortality in patients. The evidence on the risk factors for HAEC remains inconclusive to date. Methods: Four English databases and four Chinese databases were searched for relevant studies published until May 2022. The search retrieved 53 relevant studies. The retrieved studies were scored on the Newcastle–Ottawa Scale by three researchers. Revman 5.4 software was employed for data synthesis and analysis. Stata 16 software was employed for sensitivity analysis and bias analysis. Results: A total of 53 articles were retrieved from the database search, which included 10 012 cases of HSCR and 2310 cases of HAEC. The systematic analysis revealed anastomotic stenosis or fistula [I 2=66%, risk ratio (RR)=1.90, 95% CI 1.34–2.68, P<0.001], preoperative enterocolitis (I 2=55%, RR=2.07, 95% CI 1.71–2.51, P<0.001), preoperative malnutrition (I 2=0%, RR=1.96, 95% CI 1.52–2.53, P<0.001), preoperative respiratory infection or pneumonia (I 2=0%, RR=2.37, 95% CI 1.91–2.93, P<0.001), postoperative ileus (I 2=17%, RR=2.41, 95% CI 2.02–2.87, P<0.001), length of ganglionless segment greater than 30 cm (I 2=0%, RR=3.64, 95% CI 2.43–5.48, P<0.001), preoperative hypoproteinemia (I 2=0%, RR=1.91, 95% CI 1.44–2.54, P<0.001), and Down syndrome (I 2=29%, RR=1.65, 95% CI 1.32–2.07, P<0.001) as the risk factors for postoperative HAEC. Short-segment HSCR (I 2=46%, RR=0.62, 95% CI 0.54–0.71, P<0.001) and transanal operation (I 2=78%, RR=0.56, 95% CI 0.33–0.96, P=0.03) were revealed as the protective factors against postoperative HAEC. Preoperative malnutrition (I 2=35 % , RR=5.33, 95% CI 2.68–10.60, P<0.001), preoperative hypoproteinemia (I 2=20%, RR=4.17, 95% CI 1.91–9.12, P<0.001), preoperative enterocolitis (I 2=45%, RR=3.51, 95% CI 2.54–4.84, P<0.001), and preoperative respiratory infection or pneumonia (I 2=0%, RR=7.20, 95% CI 4.00–12.94, P<0.001) were revealed as the risk factors for recurrent HAEC, while short-segment HSCR (I 2=0%, RR=0.40, 95% CI 0.21–0.76, P=0.005) was revealed as a protective factor against recurrent HAEC. Conclusion: The present review delineated the multiple risk factors for HAEC, which could assist in preventing the development of HAEC.

Background Pectus excavatum (PE) is the most common disease of chest wall deformity, with an incidence of 1 in 300—400 births. Nuss procedure has proved to be the best surgical treatment method and has been widely used after clinical use for 30 years. We aimed to review the clinical data of pectus excavatum (PE) of thoracoscopic Nuss procedure adopted the Modified bar bending method of the six-point seven-section type, and compare it with the traditional curved bar bending method to explore the clinical application effect. Methods Forty-six cases of clinical data were summarized of children with PE who adopted the treatment of the Modified bar bending method of the six-point seven-section type from January 2019 to December 2021, and 51 cases were compared of PE children who adopted the treatment of traditional curved bar bending method from January 2016 to December 2018, including the data of age, gender, preoperative symptoms, symmetry, Haller index, operation time, bar bending time, intraoperative bleeding, postoperative complications, bar migration, postoperative effect evaluation, etc. Results The Procedure duration (P = 0.008), bar bending time (P < 0.001), and duration of postoperative pain (P < 0.001) were reduced significantly, and the incidence of bar migration after surgery was reduced as well by the modified bar bending method. There was no difference compared with traditional Nuss produce, like the incidence of evaluation of postoperative effects (Excellent, P = 0.93; Good, P = 0.80; Medium, P = 1.00; Poor, P = 1.00), bar migration (P = 1.00), postoperative complications (P = 1.00), Clavien- Dindo classification of surgical complications (I = 0.165; II = 1.00; IIIa = 1.00; IIIb = 1.00; VI = 1.00; V = 1.00), operative safety, and operative validity. Conclusion Modified bar bending method of the six-point seven-section type, which is a kind of surgical method worth applying and popularizing, and the advantages of minimally procedure duration, bar bending time, and duration of postoperative pain, compared with the traditional bar bending method.