The relationship of eosinophilia with outcomes of Hirschsprung disease in children

Sola, Richard; Poola, Ashwini S.; Memon, Rmaah; Singh, Vivekanand; Hendrickson, Richard J.; Peter, Shawn D. St.; Fraser, Jason D.

doi:10.1007/s00383-018-04430-9

Cited by 3 publications

(2 citation statements)

References 16 publications

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“…Previous investigations have demonstrated no statistically significant difference in postoperative outcomes of HSCR patients with and without mucosal eosinophilia present on rectal biopsies. 5 Though high-risk features for postoperative complications have been documented, pathophysiologic determinants of perioperative morbidity, including anastomotic leak and persistent-recurrent episodes of Hirschsprung associated enterocolitis (HAEC), are largely unknown. [6][7][8] Limited work has been published specifically addressing the mucosal defense system and gut immunity, largely proposing compromised mucosal integrity and alterations in epithelial permeability as potential etiologies of the observed morbidity in HSCR patients postoperatively.…”

Section: Introductionmentioning

confidence: 99%

“…This pathologic finding is separate and distinct from that of eosinophilic infiltration. Previous investigations have demonstrated no statistically significant difference in postoperative outcomes of HSCR patients with and without mucosal eosinophilia present on rectal biopsies 5 . Though high‐risk features for postoperative complications have been documented, pathophysiologic determinants of perioperative morbidity, including anastomotic leak and persistent‐recurrent episodes of Hirschsprung associated enterocolitis (HAEC), are largely unknown 6–8 .…”

Section: Introductionmentioning

confidence: 99%

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Clinical relevance of inflammation on rectal biopsy for Hirschsprung disease: An outcomes analysis

Lotakis,

Rubalcava,

Lopyan

et al. 2023

J. pediatr. gastroenterol. nutr.

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ObjectivesInflammation on diagnostic rectal biopsy for children with suspected Hirschsprung disease (HSCR) is reported on pathology, and its significance is unknown. We describe the management and outcomes of a cohort with inflammation on rectal biopsy compared to those without. Specifically, to address the hypothesis that inflammation on diagnostic biopsy is associated with increased complication rates irrespective of intervention type and timing.MethodsA single institution retrospective review of children with HSCR who underwent biopsy and endorectal pull‐through (ERPT) from 2010 to 2020 was performed. The primary outcome was overall complications at 30‐days following ERPT. Secondary outcomes included timing and type of operative intervention as well as postoperative enterocolitis diagnosed within 6‐months of ERPT.ResultsForty‐nine children were identified; inflammation was present on diagnostic biopsy for 17 children. Those with inflammation were more likely to have clinical evidence of enterocolitis at the time of biopsy (p = 0.001) and were more likely to undergo leveling colostomy before ERPT (p = 0.01). Children with inflammation had a higher anastomotic leak rate (p = 0.04). Subgroup analysis of patients with inflammation undergoing primary ERPT versus leveling colostomy demonstrated no significant difference in outcomes following definitive ERPT.ConclusionsOur study suggests inflammation on diagnostic rectal biopsy for HSCR is associated with increased anastomotic leak rates. While additional prospective studies are indicated, attention to methods of mitigating inflammation and confirming its resolution before definitive pull‐through may be of benefit for improving clinical outcomes in patients found with inflammation on diagnostic rectal biopsy.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical relevance of inflammation on rectal biopsy for Hirschsprung disease: An outcomes analysis

Lotakis,

Rubalcava,

Lopyan

et al. 2023

J. pediatr. gastroenterol. nutr.

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The incidence of abdominal surgical site infections after abdominal birth defects surgery in infants: A systematic review with meta-analysis

Schattenkerk

Musters

Nijssen

et al. 2021

Journal of Pediatric Surgery

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Background: : Surgical site infections (SSI) are a frequent and significant problem understudied in infants operated for abdominal birth defects. Different forms of SSIs exist, namely wound infection, wound dehiscence, anastomotic leakage, post-operative peritonitis and fistula development. These complications can extend hospital stay, surge medical costs and increase mortality. If the incidence was known, it would provide context for clinical decision making and aid future research. Therefore, this review aims to aggregate the available literature on the incidence of different SSIs forms in infants who needed surgery for abdominal birth defects. Method: : The electronic databases Pubmed, EMBASE, and Cochrane library were searched in February 2020. Studies describing infectious complications in infants (under three years of age) were considered eligible. Primary outcome was the incidence of SSIs in infants. SSIs were categorized in wound infection, wound dehiscence, anastomotic leakage, postoperative peritonitis, and fistula development. Secondary outcome was the incidence of different forms of SSIs depending on the type of birth defect. Meta-analysis was performed pooling reported incidences in total and per birth defect separately. Results: : 154 studies, representing 11,786 patients were included. The overall pooled percentage of wound infections after abdominal birth defect surgery was 6% (95%-

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The incidence of different forms of ileus following surgery for abdominal birth defects in infants: a systematic review with a meta-analysis method

Schattenkerk

Musters

Nijssen

et al. 2021

Innovative Surgical Sciences

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Objectives Ileus following surgery can arise in different forms namely as paralytic ileus, adhesive small bowel obstruction or as anastomotic stenosis. The incidences of these different forms of ileus are not well known after abdominal birth defect surgery in infants. Therefore, this review aims to estimate the incidence in general between abdominal birth defects. Content Studies reporting on paralytic ileus, adhesive small bowel obstruction or anastomotic stenosis were considered eligible. PubMed and Embase were searched and risk of bias was assessed. Primary outcome was the incidence of complications. A meta-analysis was performed to pool the reported incidences in total and per birth defect separately. Summary This study represents a total of 11,617 patients described in 152 studies of which 86 (56%) had a follow-up of at least half a year. Pooled proportions were calculated as follows; paralytic ileus: 0.07 (95%-CI, 0.05–0.11; I 2=71%, p≤0.01) ranging from 0.14 (95% CI: 0.08–0.23) in gastroschisis to 0.05 (95%-CI: 0.02–0.13) in omphalocele. Adhesive small bowel obstruction: 0.06 (95%-CI: 0.05–0.07; I 2=74%, p≤0.01) ranging from 0.11 (95% CI: 0.06–0.19) in malrotation to 0.03 (95% CI: 0.02–0.06) in anorectal malformations. Anastomotic stenosis after a month 0.04 (95%-CI: 0.03–0.06; I 2=59%, p=0.30) ranging from 0.08 (95% CI: 0.04–0.14) in gastroschisis to 0.02 (95% CI: 0.01–0.04) in duodenal obstruction. Anastomotic stenosis within a month 0.03 (95%-CI 0.01–0.10; I 2=81%, p=0.02) was reviewed without separate analysis per birth defect. Outlook This review is the first to aggregate the known literature in order approximate the incidence of different forms of ileus for different abdominal birth defects. We showed these complications are common and the distribution varies between birth defects. Knowing which birth defects are most at risk can aid clinicians in taking prompt action, such as nasogastric tube placement, when an ileus is suspected. Future research should focus on the identification of risk factors and preventative measures. The incidences provided by this review can be used in those studies as a starting point for sample size calculations.

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The relationship of eosinophilia with outcomes of Hirschsprung disease in children

Cited by 3 publications

References 16 publications

Clinical relevance of inflammation on rectal biopsy for Hirschsprung disease: An outcomes analysis

Clinical relevance of inflammation on rectal biopsy for Hirschsprung disease: An outcomes analysis

The incidence of abdominal surgical site infections after abdominal birth defects surgery in infants: A systematic review with meta-analysis

The incidence of different forms of ileus following surgery for abdominal birth defects in infants: a systematic review with a meta-analysis method

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