Early and Late Complications Following Pull-Through Operation for Hirschsprung’s Disease

Rentea, Rebecca M.; Snyder, Charles L.

doi:10.1007/978-3-030-15647-3_26

Cited by 3 publications

(4 citation statements)

References 54 publications

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“…Traditionally, SS-HSCR has been treated by single or multistage trans-anal pull-through procedures, although high morbidity up to 40% is reported. [3][4][5] Minimally invasive transanal or endorectal approaches have also reported high incidence of internal anal sphincter damage. [8] In contrast to this, PREM brings new hope to these patients with SS-HSCR.…”

Section: Discussionmentioning

confidence: 99%

“…Supplementary material is available under https://doi.org/10.1055/a-1332-6902 [3][4][5]. An alternative, surgical posterior anorectal myotomy/ myectomy, has been described, based on the principle of disruption of the spastic aganglionic segment.…”

Section: Table S1 S2mentioning

confidence: 99%

“…[2] Although, traditional paradigm in HSCR has been resection of aganglionic segment and reconstruction using pull-through operations with colo-anal anastomosis; these operations are invasive and carry high morbidity. [3][4][5] An alternative -surgical posterior anorectal myotomy/myectomy (PARM) was described, based on principle of disruption of the spastic aganglionic segment. This technique was effective in patients with USS-HSCR limited to distal 5-8 cm.…”

Section: Introductionmentioning

confidence: 99%

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Initial experience with per-rectal endoscopic myotomy for Hirschsprung’s disease: medium and long term outcomes of the first case series of a novel third-space endoscopy procedure

et al. 2020

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Introduction Hirschsprung’s disease (HSCR) is congenital aganglionosis affecting hindgut and presents with constipation. Surgical pull-through is current standard but has morbidity. Per-rectal endoscopic myotomy (PREM) is a novel third space endoscopy technique for treating SS-HSCR. Methods Retrospective series of SS-HSCR patients diagnosed on history, contrast enema, rectal biopsies, anorectal manometry and treated by PREM. Aganglionic segment mapped pre-PREM. PREM performed using third space endoscopy principles. Objective – to compare stool frequency and unit laxative (UL) usage pre and post-PREM. Results N = 9; duration 4-years. Mean age – 7.5 (± 5.2) years; 7 males. Mean aganglionic segment length – 6.3 (± 4.4) cm. Mean procedure time – 96.1 (±37.9) minutes. Mean LOS – 2.5 (±0.7) days. Median follow-up –17 months (9 – 58). Stool frequency – pre – 1/4.4 (±1.5) vs. post – 1/1.2 (±0.4) days (p = 0.0004). Mean UL usage – pre – 5.4 (±4.9) vs. post – 0.4 (±0.7) units (p = 0.0002). No laxatives in 6 (66%). Single AE (anal stenosis) – dilatation. Conclusions PREM is a safe and effective minimally invasive procedure for SS-HSCR and provides long-term response.

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Section: Discussionmentioning

confidence: 99%

Section: Table S1 S2mentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Initial experience with per-rectal endoscopic myotomy for Hirschsprung’s disease: medium and long term outcomes of the first case series of a novel third-space endoscopy procedure

et al. 2020

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“…In the realm of pediatric surgery, the role of nutritional support during the postoperative recovery phase, especially after procedures such as colostomy closure, has emerged as a subject of increasing interest and debate among medical professionals (1). Historically, the practice of withholding food and fluids (NPO -nil per os) post-surgery was widely accepted as a precautionary measure to prevent complications like vomiting, anastomotic leak, and wound infections (2,3). This traditional approach, deeply rooted in medical practice, is being reconsidered in light of recent advancements and evidence suggesting that early enteral feeding could significantly enhance recovery outcomes (4).…”

Section: Introductionmentioning

confidence: 99%

Comparison of Outcome in Early Vs Conventional Feeding after Colostomy Closure in Paediatric Population

Bajwa,

Din,

Chattha

et al. 2024

JHRR

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Background: The traditional practice of delaying enteral feeding after pediatric colostomy closure has been a subject of reconsideration in the wake of emerging evidence suggesting the benefits of early enteral nutrition. The hypothesis driving this shift stems from the understanding that early feeding may enhance recovery by improving gut function and reducing hospital stay, which is particularly significant in the pediatric population where rapid return to normal activities and minimizing hospital-associated stress are crucial. Objective: This study aimed to compare the outcomes of early enteral feeding versus conventional feeding protocols post-colostomy closure in pediatric patients, focusing on parameters such as the incidence of postoperative complications, the duration of hospital stay, and overall recovery. Methods: Conducted as a randomized controlled trial at the Department of Pediatric Surgery, Children Hospital, Lahore, this study enrolled 70 pediatric patients, evenly divided into two groups: early enteral feeding (Group A) and conventional feeding (Group B). Both groups were meticulously matched for age, weight, and gender to ensure comparability. The study meticulously recorded and analyzed postoperative outcomes including anastomotic leakage, vomiting, upper respiratory tract infections (URTI), wound infections, and other complications using chi-square and t-tests for statistical significance. Results: The mean age of patients was 6.67 ± 3.42 years, with a balanced distribution between the groups (p = 0.917). In Group A, 8.6% experienced anastomotic leakage compared to 11.4% in Group B; vomiting occurred in 11.4% of Group A and 8.6% of Group B; URTI was noted in 2.9% of Group A versus 14.3% in Group B; wound infection rates were 8.6% for Group A and 14.3% for Group B. The average post-operative hospital stay significantly favored Group A at 4.26 ± 0.43 days versus 7.05 ± 0.32 days for Group B (p = 0.0001). Conclusion: Early enteral feeding after pediatric colostomy closure significantly reduces the hospital stay without increasing the risk of postoperative complications, suggesting a beneficial role in pediatric surgical recovery. This study supports the integration of early feeding protocols into postoperative care for pediatric colostomy patients, contributing to the evolving practice of pediatric surgery.

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Outcomes following endorectal pull-through for Hirschsprung disease: a retrospective study

AbouZeid,

AbdelMalek

2024

Egypt Pediatric Association Gaz

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Purpose To share our experience in the surgical management of patients with Hirschsprung disease (HD) using the trans-anal endorectal pull-through “Soave” technique. Methods The study included cases diagnosed as HD who were operated during the period 2008 through 2018. Cases of total colonic aganglionosis were excluded to be discussed in a separate report. Results The study included 67 consecutive cases of HD. All included cases underwent trans-anal endorectal pull-through which was purely trans-anal in 31 (46%), while abdominal-assisted trans-anal endorectal pull-through was applied in the remaining (54%). Early postoperative complications included 2 cases of partial dehiscence at the colo-anal anastomosis; 1 of them deteriorated after re-exploration and unfortunately died. Twenty-six cases were available to assess functional outcomes after corrective surgery. Their age at follow-up ranged between 44 months and 17 years (mean = 78.8 months; median = 72 months). All cases achieved voluntary defecation. However, fecal soiling was a common finding after surgery for HD (69%). Constipation was another common postoperative finding (73%). Lastly, a history of attacks of postoperative enterocolitis was prevalent in 19 cases (73%), which ranged between 1 and 7 attacks usually in the first 2 years after the operation. Conclusion The trans-anal endorectal pull-through provides an effective surgical treatment for Hirschsprung disease. The high prevalence of fecal soiling after surgery highlights the importance of long-term follow-up to provide the required support for these patients during adolescence and transition into adulthood.

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Early and Late Complications Following Pull-Through Operation for Hirschsprung’s Disease

Cited by 3 publications

References 54 publications

Initial experience with per-rectal endoscopic myotomy for Hirschsprung’s disease: medium and long term outcomes of the first case series of a novel third-space endoscopy procedure

Initial experience with per-rectal endoscopic myotomy for Hirschsprung’s disease: medium and long term outcomes of the first case series of a novel third-space endoscopy procedure

Comparison of Outcome in Early Vs Conventional Feeding after Colostomy Closure in Paediatric Population

Outcomes following endorectal pull-through for Hirschsprung disease: a retrospective study

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