Continuous transanal decompression for infants with long- and total-type Hirschsprung’s diseases as a bridge to curative surgery: a single-center experience

Abstract

BackgroundThe purpose of this study is to assess the usefulness of continuous bowel decompression using an indwelling transanal tube (ITT) for preoperative management in infants with long-segment (L)- or total (T)-type Hirschsprung’s disease (HD).Case presentationBetween 2012 and 2015, seven patients with L- or T-type HD underwent preoperative bowel management by continuous bowel decompression using an ITT during waiting period for curative surgery. Continuous bowel decompression was done using an ITT, a 10–12F flexible dual lumen tube placed through the rectum up to the dilated colon under fluoroscopic guidance and secured to the bilateral buttocks. The ITT tips were located at least in a dilated colon or the cecum if there was no radiographic transitional zone. The ITT was left open for continuous drainage, and its patency was checked by regular suction until the curative operation. The patient status and complications of this preoperative management were reviewed retrospectively.ResultsThe median duration of decompression management was 65 (17–137) days. During decompression period, neither abdominal distention, enterocolitis, nor other complications occurred and six patients could stay at home until the curative operation. The weight-for-age Z-score at curative surgery was the same as or higher than that at birth in five patients. ITT replacement was needed three times per patient on an average for accidental ITT removal, ITT stenosis, or ITT hardening.ConclusionsBowel management by continuous bowel decompression using an ITT is easy, safe, and effective for preoperative management in patients with L- or T-type HD and may permit single-stage surgery rendering colostomy or enterostomy unnecessary.

Blowhole tangential cecostomy and transanal tube insertion for neonatal cecal perforation in a patient with Hirschsprung’s disease in the earlier definitive operation era

“…In contrast to loop colostomy, a tangential-type stoma can act as a decompression and diversion window but cannot accomplish the complete division of the fecal stream. A transanal indwelling tube can manage the inflow feces and gas into the distal aganglionic bowel until definitive surgery [5–7]. Hirose et al [6] reported that transanal catheter fixation enabled decompression and prevention of enterocolitis before surgery in 2 neonates with long-segment HD, which allowed the performance of the single-stage early transanal pull-through procedure with laparoscopy.…”

Feasibility of home and hospital colorectal irrigation with continuous tube placement for Hirschsprung’s disease in neonates and infants: a comparative retrospective study

“…2). The method of fixation to the patient's hip was according to the technique described previously [5]. The tube was tied with a thread and was fixed by applying a tape to the hip using the thread (Fig.…”

“…Hirose et al first reported a method of transanal catheter fixation and colonic irrigation for the preoperative management of neonates with HD [4]. Mochizuki et al also 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; thus, the radical surgery can be made semielectively.…”