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Zhang X, Sun D, Xu Q, Liu H, Li Y, Wang D, Wang J, Zhang Q, Hou P, Mu W, Jia C, Li A. Risk factors for Hirschsprung disease-associated enterocolitis: a systematic review and meta-analysis. Int J Surg 2023; 109:2509-2524. [PMID: 37288551 PMCID: PMC10442125 DOI: 10.1097/js9.0000000000000473] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 05/08/2023] [Indexed: 06/09/2023]
Abstract
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 [ I2 =66%, risk ratio (RR)=1.90, 95% CI 1.34-2.68, P <0.001], preoperative enterocolitis ( I2 =55%, RR=2.07, 95% CI 1.71-2.51, P <0.001), preoperative malnutrition ( I2 =0%, RR=1.96, 95% CI 1.52-2.53, P <0.001), preoperative respiratory infection or pneumonia ( I2 =0%, RR=2.37, 95% CI 1.91-2.93, P <0.001), postoperative ileus ( I2 =17%, RR=2.41, 95% CI 2.02-2.87, P <0.001), length of ganglionless segment greater than 30 cm ( I2 =0%, RR=3.64, 95% CI 2.43-5.48, P <0.001), preoperative hypoproteinemia ( I2 =0%, RR=1.91, 95% CI 1.44-2.54, P <0.001), and Down syndrome ( I2 =29%, RR=1.65, 95% CI 1.32-2.07, P <0.001) as the risk factors for postoperative HAEC. Short-segment HSCR ( I2 =46%, RR=0.62, 95% CI 0.54-0.71, P <0.001) and transanal operation ( I2 =78%, RR=0.56, 95% CI 0.33-0.96, P =0.03) were revealed as the protective factors against postoperative HAEC. Preoperative malnutrition ( I2 =35 % , RR=5.33, 95% CI 2.68-10.60, P <0.001), preoperative hypoproteinemia ( I2 =20%, RR=4.17, 95% CI 1.91-9.12, P <0.001), preoperative enterocolitis ( I2 =45%, RR=3.51, 95% CI 2.54-4.84, P <0.001), and preoperative respiratory infection or pneumonia ( I2 =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 ( I2 =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.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Chunling Jia
- Stomatology, Qilu Hospital of Shandong University, Jinan, China
| | - Aiwu Li
- Departments ofPediatric surgery
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Update on the Pathogenesis of the Hirschsprung-Associated Enterocolitis. Int J Mol Sci 2023; 24:ijms24054602. [PMID: 36902033 PMCID: PMC10003052 DOI: 10.3390/ijms24054602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 03/03/2023] Open
Abstract
Despite the significant progress that has been made in terms of understanding the pathophysiology and risk factors of Hirschsprung-associated enterocolitis (HAEC), the morbidity rate has remained unsatisfactorily stable, and clinical management of the condition continues to be challenging. Therefore, in the present literature review, we summarized the up-to-date advances that have been made regarding basic research on the pathogenesis of HAEC. Original articles published between August 2013 and October 2022 were searched in a number of databases, including PubMed, Web of Science, and Scopus. The keywords "Hirschsprung enterocolitis", "Hirschsprung's enterocolitis", "Hirschsprung's-associated enterocolitis", and "Hirschsprung-associated enterocolitis" were selected and reviewed. A total of 50 eligible articles were obtained. The latest findings of these research articles were grouped into gene, microbiome, barrier function, enteric nervous system, and immune state categories. The present review concludes that HAEC is shown to be a multifactorial clinical syndrome. Only deep insights into this syndrome, with an accrual of knowledge in terms of understanding its pathogenesis, will elicit the necessary changes that are required for managing this disease.
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Hirschsprung disease in Down syndrome: An opportunity for improvement. J Pediatr Surg 2022; 57:1040-1044. [PMID: 35279286 DOI: 10.1016/j.jpedsurg.2022.01.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 01/31/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Down syndrome (DS) is the most common abnormality associated with Hirschsprung disease (HD). It has been suggested patients with HD and DS have worse outcomes, however the literature is controversial. METHODS The Kids' Inpatient Database (KID) from 2003 to 2012 was used to identify newborns with HD. Demographics, hospital characteristics, and outcomes were compared among patients with and without DS using standard statistical tests. RESULTS There were 481 patients identified with HD, of which 45 (9%) had DS. Patients with DS were older at the time of first rectal biopsy (6 [3-11] days vs. 4 [3-6] days, p = 0.012). There were no differences in operative versus non-operative management in patients with and without DS (p = 0.706). Hospital length of stay was longer in the DS cohort (22 [13-33] days vs. 15 [10-24] days, p = 0.019), and patients with DS were more likely to have a concomitant diagnosis of wound infection (<12% vs. 3%, p = 0.002) and necrotizing enterocolitis (<14% vs. 5%, p = 0.018). The mortality rate for patients with DS was four times higher than those without DS (< 5% vs. < 0.8%, p = 0.018). CONCLUSION In this nationwide cohort of patients with Hirschsprung disease, those with Down syndrome experienced delays in diagnosis and worse outcomes. LEVEL OF EVIDENCE Level III. TYPE OF STUDY Treatment study, retrospective comparative study.
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Roorda D, Oosterlaan J, van Heurn E, Derikx JPM. Risk factors for enterocolitis in patients with Hirschsprung disease: A retrospective observational study. J Pediatr Surg 2021; 56:1791-1798. [PMID: 34078551 DOI: 10.1016/j.jpedsurg.2021.04.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 04/10/2021] [Accepted: 04/18/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Hirschsprung-associated enterocolitis (HAEC) accounts for substantial morbidity and mortality in patients with Hirschsprung disease (HD). The aim of this study was to identify incidence of pre- and postoperative HAEC in our consecutive cohort and to identify patient and clinical characteristics that are associated with developing postoperative HAEC and HAEC-free interval. MATERIAL AND METHODS A retrospective cohort study was performed with all 146 HD patients treated between 2000 and 2017. Data were retrieved from the medical records. HAEC was defined as presence of clinical signs of bowel inflammation, that required treatment with intravenous antibiotics and admittance to the hospital during at least two days. To identify risk factor for HAEC, patients with and without a history of postoperative HAEC were compared. Kaplan-Meier and Cox-regression were used to assess HAEC free intervals before and after surgery. RESULTS Out of 146 patients, 12 patients had pre-operative HAEC (8%) and 31 patients had postoperative HAEC (21%). Median preoperative HAEC free interval was 112 days (IQR 182 days). Length of hospital stay due to readmissions was longer for patients with a history of postoperative HAEC compared to patients without a history of postoperative HAEC (9.5 vs 16 days, U = 1872.5, p = 0.047). Median postoperative HAEC free interval was 226 days. Of the patients who had postoperative HAEC, 66% had their first episode within the first year after surgery and that the incidence of HAEC declined over follow-up. CONCLUSIONS HAEC incidence was relatively low in our population. No patient or clinical characteristics were associated with the risk of postoperative HAEC.
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Affiliation(s)
- Daniëlle Roorda
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Department of Pediatric Surgery, Amsterdam Gastroenterology and Metabolism Research Institute and Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands; Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Follow Me Follow-Up Program, Department of Pediatrics, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands.
| | - Jaap Oosterlaan
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Follow Me Follow-Up Program, Department of Pediatrics, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Ernest van Heurn
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Department of Pediatric Surgery, Amsterdam Gastroenterology and Metabolism Research Institute and Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Joep P M Derikx
- Emma Children's Hospital, Amsterdam UMC, University of Amsterdam and Vrije Universiteit Amsterdam, Department of Pediatric Surgery, Amsterdam Gastroenterology and Metabolism Research Institute and Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
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Taylor MA, Bucher BT, Reeder RW, Avansino JR, Durham M, Calkins CM, Wood RJ, Levitt MA, Drake K, Rollins MD. Comparison of Hirschsprung Disease Characteristics between Those with a History of Postoperative Enterocolitis and Those without: Results from the Pediatric Colorectal and Pelvic Learning Consortium. Eur J Pediatr Surg 2021; 31:207-213. [PMID: 32947626 DOI: 10.1055/s-0040-1716876] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION The current understanding of Hirschsprung-associated enterocolitis (HAEC) is based mainly on single-center, retrospective studies. The aims of this study are to determine risk factors for postoperative HAEC using the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) database. MATERIALS AND METHODS We performed a multicenter, retrospective, case-control study of children with Hirschsprung disease (HD) who had undergone a pull-through procedure and were evaluated at a PCPLC member site between February 2017 and March 2020. The cohort with a history of postoperative HAEC was compared with that without postoperative episodes of HAEC to determine relevant associations with postoperative HAEC. RESULTS One-hundred forty of 299 (46.8%) patients enrolled had a history of postoperative HAEC. Patients with a rectosigmoid transition zone had a lower association with postoperative HAEC as compared with those with a more proximal transition zone (odds ratio [OR]: 0.46, 95% confidence interval [CI]: 0.26, 0.84, p < 0.01). Private insurance was protective against postoperative HAEC on univariate analysis (OR: 0.62, 95% CI: 0.38, 0.99, p = 0.047), but not on multivariate analysis (OR: 0.62, 95% CI: 0.37, 1.04, p = 0.07). Preoperative HAEC was not associated with the development of postoperative HAEC. CONCLUSION Patients with a rectosigmoid transition zone have less postoperative HAEC compared with patients with a more proximal transition zone. Multi-institutional collection of clinical information in patients with HD may allow for the identification of additional risk factors for HAEC and afford the opportunity to improve care.
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Affiliation(s)
- Mark A Taylor
- Department of Surgery, University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, Utah, United States
| | - Brian T Bucher
- Department of Surgery, University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, Utah, United States
| | - Ron W Reeder
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Jeffrey R Avansino
- Department of Pediatric Surgery, Seattle Children's, Seattle, Washington, United States
| | - Megan Durham
- Division of Pediatric Surgery, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, United States
| | - Casey M Calkins
- Department of Pediatric Surgery, Children's Wisconsin, Milwaukee, Wisconsin, United States
| | - Richard J Wood
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, Ohio, United States
| | - Marc A Levitt
- Department Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, District of Columbia, Washington, United States
| | - Kaylea Drake
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, United States
| | - Michael D Rollins
- Department of Surgery, University of Utah School of Medicine and Primary Children's Hospital, Salt Lake City, Utah, United States
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Predictive factors for the development of postoperative Hirschsprung-associated enterocolitis in children operated during infancy. Pediatr Surg Int 2021; 37:275-280. [PMID: 33245447 DOI: 10.1007/s00383-020-04784-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The risk factors for postoperative Hirschsprung-associated enterocolitis (HAEC) are still incompletely understood, especially age at which surgery is performed. Therefore, the aim of this study was to identify the risk factors for the development of postoperative HAEC in children operated during infancy. METHODS Thirty-five children who had undergone radical surgery for Hirschsprung disease (HD) during infancy were included in the study. They were divided into two groups; those who developed postoperative HAEC (HAEC, 14 patients) and those who did not (no HAEC, 21 patients). Their medical records were retrospectively reviewed for clinical details. RESULTS Developing postoperative HAEC was significantly associated with long-segment HD (p = 0.020) and the age at radical surgery (p = 0.0241). No other factors had a significant association with postoperative HAEC. In the patients who developed postoperative HAEC (n = 14), those with Trisomy 21 had significantly longer hospitalizations than those without. Patients with long-segment HD had a higher hospitalization rate than those with short-segment HD. CONCLUSION This study clearly showed that long-segment HD and older age at radical surgery are risk factors for developing postoperative HAEC.
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Wall N, Kastenberg Z, Zobell S, Mammen L, Rollins MD. Use of an enterocolitis triage and treatment protocol in children with Hirschsprung disease reduces hospital admissions. J Pediatr Surg 2020; 55:2371-2374. [PMID: 32553451 DOI: 10.1016/j.jpedsurg.2020.05.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 04/09/2020] [Accepted: 05/03/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND While a consensus for the definition of Hirschsprung associated enterocolitis (HAEC) is lacking, the mainstay of treatment includes rectal irrigations with or without antibiotics. This treatment is often effective when initiated as an outpatient. Our institution implemented a triage algorithm in an effort to standardize care thus providing more timely treatment and preventing unnecessary hospital admissions. We sought to review our short-term experience. METHODS A retrospective review was performed of all Hirschsprung (HD) patients <6 years old over two distinct time periods from May 2016-2017 (pre-protocol, group A) and June 2017-2018 (post-protocol, group B). Patients with a colostomy were excluded. Primary end point was hospital admission. Presenting symptoms were categorized as moderate or severe, with patient triage based on number and quality of symptoms. RESULTS Eighty-seven total patients were included. Rectosigmoid transition zone was most common (75%) and 20% of patients had trisomy 21. HAEC occurred in 22% of patients in the preprotocol group (group A, n = 78, 27 episodes) and 20% of patients in the post-protocol group (group B, n = 87, 32 episodes). In group A, 78% of episodes required an unplanned visit and 74% resulted in admission. In group B, 81% of episodes required an unplanned visit and 50% resulted in admission (33% reduction in hospital admission, p = 0.06). Irrigations only, without antibiotics, were used in 30% of episodes in group A versus 41% in group B. Of patients who initially contacted the office by phone (group A = 7 episodes, group B = 6 episodes), outpatient management was successful in 43% versus 100% respectively (p = 0.07). No patient experienced increased morbidity in group B. DISCUSSION Implementation of a HAEC treatment algorithm shows promise in improving the management and resource utilization of this complex patient population. It is anticipated that continued education of caregivers and the treatment team will result in a greater effect. A multi-institutional implementation of this algorithm is needed to characterize risk factors associated with failure of outpatient management. LEVEL OF EVIDENCE III, Treatment Study.
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Affiliation(s)
- Natalie Wall
- Primary Children's Hospital, University of Utah School of Medicine, SLC, UT.
| | - Zachary Kastenberg
- Primary Children's Hospital, University of Utah School of Medicine, SLC, UT
| | - Sarah Zobell
- Primary Children's Hospital, University of Utah School of Medicine, SLC, UT
| | - Lija Mammen
- Primary Children's Hospital, University of Utah School of Medicine, SLC, UT
| | - Michael D Rollins
- Primary Children's Hospital, University of Utah School of Medicine, SLC, UT
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Pruitt LC, Skarda DE, Rollins MD, Bucher BT. Hirschsprung-associated enterocolitis in children treated at US children's hospitals. J Pediatr Surg 2020; 55:535-540. [PMID: 31836243 PMCID: PMC7780549 DOI: 10.1016/j.jpedsurg.2019.10.060] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/30/2019] [Indexed: 12/25/2022]
Abstract
BACKGROUND The incidence of and risk factors for Hirschsprung's-associated enterocolitis (HAEC) following pull-through have been limited to single institutions studies. We characterized the incidence of, risk factors for, and consequences of post-operative HAEC. METHODS We identified children with Hirschsprung's Disease (HD) at US Children's Hospitals from 2007 to 2017 with and an associated pull-through operation at less than 1 year of age. HAEC readmissions were identified using ICD9/10 Diagnosis Codes and antibiotic administration. Hierarchical logistic regression models were developed for the risk factors for HAEC after pull-through and effects of recurrent HAEC on HD-related reoperations. RESULTS We identified 2030 children with HD, and 138 (7%) who had two or more readmissions related to HAEC. The frequency of recurrent HAEC by hospital ranged from 0 to 33%. Pre-operative HAEC, history of central nervous system infection, and congenital neurologic anomalies were associated with increased risk of recurrent HAEC. Recurrent HAEC was associated with HD-specific re-operation (OR 5.2, CI 3.3-8.1, p < 0.001); however, it was not associated with risk of in-hospital mortality (OR 3.3, CI 0.88-12.1, p = 0.08). CONCLUSIONS HAEC following pull-through occurs in a large proportion of infants with HD and predicts reoperation. Multicenter studies are needed to develop prediction models and treatment protocols for HAEC. LEVEL OF EVIDENCE II TYPE OF STUDY: Retrospective cohort study.
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Affiliation(s)
- Liese C.C. Pruitt
- University of Utah, Department of Surgery, Division of Pediatric Surgery, Salt Lake City, UT,Corresponding author at: 30 N. 1900 E., RM 3B322, Salt Lake City, UT, 84132., , (L.C.C. Pruitt)
| | - David E. Skarda
- University of Utah, Department of Surgery, Division of Pediatric Surgery, Salt Lake City, UT,Primary Children’s Hospital, Intermountain Health Care, Salt Lake City, UT
| | - Michael D. Rollins
- University of Utah, Department of Surgery, Division of Pediatric Surgery, Salt Lake City, UT,Primary Children’s Hospital, Intermountain Health Care, Salt Lake City, UT
| | - Brian T. Bucher
- University of Utah, Department of Surgery, Division of Pediatric Surgery, Salt Lake City, UT,Primary Children’s Hospital, Intermountain Health Care, Salt Lake City, UT
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Pini Prato A, Arnoldi R, Sgrò A, Felici E, Racca F, Nozza P, Mariani N, Mosconi M, Mazzola C, Mattioli G. Hirschsprung disease and Down syndrome: From the reappraisal of risk factors to the impact of surgery. J Pediatr Surg 2019; 54:1838-1842. [PMID: 30814038 DOI: 10.1016/j.jpedsurg.2019.01.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 01/19/2019] [Accepted: 01/23/2019] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The association of Hirschsprung disease (HSCR) and Down Syndrome (DS) is not uncommon (HSCR+DS). This paper aims at reporting the results of a 24-year series focusing on surgical approach, complications and long term outcome. MATERIALS AND METHODS The notes of all patients admitted with a diagnosis of HSCR+DS have been retrospectively reviewed. Surgical details, intraoperative complications, long term issues and functional outcome have been recorded. The results have been compared to those of patients without DS and were assessed based on surgical approach. RESULTS A total of 23 HSCR+DS out of a series of 385 HSCR (6%) have been included. Preoperative enterocolitis (HAEC) was reported by 32%. Associated anomalies were detected in more than half of the patients. In particular, Congenital Heart Defects (CHDs) were reported by 57%. Postoperative complications (mostly symptomatic anal sphincter achalasia) were experienced by 55%. Constipation was experienced by 30%; severe continence issues, by 53%. One patient suffering from severe CHDs died. With regard to complications, only symptomatic anal achalasia requiring intrasphincteric BoTox injection was significantly more frequent in HSCR+DS (30% vs 10%, p = 0.0071). Similarly, continence proved to be significantly worse in HSCR+DS. DISCUSSION With the exception of symptomatic anal achalasia, HSCR+DS patients proved not to have a higher likelihood of complications compared to HSCR alone. On the other hand, functional results in the long term are worse. As a consequence, long term follow up and personalized rehabilitation programs are warranted for this delicate subset of HSCR patients. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Alessio Pini Prato
- Unit of Pediatric Surgery, The Children Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
| | - Rossella Arnoldi
- Unit of Pediatric Surgery, The Children Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Alberto Sgrò
- Unit of Pediatric Surgery, The Children Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Enrico Felici
- Unit of Pediatrics, The Children Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Fabrizio Racca
- Unit of Pediatric Anesthesia, The Children Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Paolo Nozza
- Pathology Unit, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy; Pathology Unit, Ospedali Galliera, Genova, Italy; "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Narcisio Mariani
- Pathology Unit, Ospedali Galliera, Genova, Italy; "Umberto Bosio" Center for Digestive Diseases, The Children Hospital, AON SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Manuela Mosconi
- Unit of Pediatric Surgery, Giannina Gaslini Institute, Genoa, Italy
| | - Cinzia Mazzola
- Unit of Pediatric Surgery, Giannina Gaslini Institute, Genoa, Italy
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Factors influencing the incidence of Hirschsprung associated enterocolitis (HAEC). J Pediatr Surg 2019; 54:959-963. [PMID: 30808539 DOI: 10.1016/j.jpedsurg.2019.01.026] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 01/27/2019] [Indexed: 12/28/2022]
Abstract
PURPOSE This study aims to characterize risk factors for Hirschsprung-associated enterocolitis (HAEC). We hypothesize that earlier pull-through surgery is associated with lower risks of developing postoperative HAEC. METHODS A comparative study of 171 Hirschsprung patients treated from 1990 to 2017 was performed. Patients without HAEC were compared to patients with preoperative and/or postoperative HAEC. Results are presented as median [IQR] or frequency (%). Pearson's χ2 test and Wilcoxon rank sum test were performed with a significance level at p < 0.05. Multivariable logistic regression analysis was used to adjust for potential confounders. A subanalysis was done to evaluate laparoscopic, laparotomy, and transanal surgeries. RESULTS Risk of developing preoperative HAEC was significantly associated with congenital malformations (OR 2.63 [1.11, 6.24]; p = 0.02). Birth weight was lower in patients with preoperative HAEC (OR 0.48 [95% CI 0.25, 0.93]; p = 0.03). On regression analysis, intestinal obstruction after surgery was significantly associated with postoperative HAEC (OR 8.2 [3.18, 21.13]; p < 0.0001). Patients with earlier pull-through surgery did not have a lower risk of developing postoperative HAEC. CONCLUSIONS Timing of surgery does not seem to be associated with a higher risk of developing pre- and postoperative HAEC. Predisposing factors for preoperative HAEC included associated malformations and lower birth weight, whereas intestinal obstruction was found to be associated with postoperative HAEC. TYPE OF STUDY Treatment study. LEVEL OF EVIDENCE Level III.
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