Impact of Colorectal Nurse Specialist supervised parental administration of rectal washouts on Hirschsprung’s disease outcomes: a retrospective review
link.springer.com shows its articles on its own site.
Read the article on link.springer.com ↗Article · Apr 2024 · 1 min read
In brief
In brief
This UK study demonstrates that colorectal nurse specialist-supervised parental training in rectal washout administration significantly reduces stoma rates in Hirschsprung's disease patients. With only 6.4% requiring stomas pre-operatively and 4.5% post-pull-through, outcomes improved compared to national benchmarks through effective home-based bowel management.
- CNS-supervised parental rectal washouts enabled primary pull-through without stoma in 93.6% of Hirschsprung's patients.
- Only 4.5% required re-diversion post-pull-through over mean 57-month follow-up, lower than recent UK benchmarks.
- HAEC requiring admission occurred in 21% of patients despite washout protocol.
- Parental competency in home rectal washouts, verified by specialist nurses, may reduce stoma dependency in HD management.
- Two TCA patients with intractable diarrhea accounted for majority of post-pull-through stoma cases.
Written by the GCMD Library team from the article.
Abstract
Purpose
To highlight the utility of Colorectal Nurse Specialist (CNS) supervised parental administration of rectal washouts in the management of Hirschsprung’s disease (HD).
Methods
Retrospective case note review of HD patients treated at a tertiary children’s hospital in United Kingdom from January 2011 to December 2022. Data collected included demographics, complications, enterocolitis, obstructive symptoms and stomas. Primary pull-through (PT) is done 8–12 weeks after birth. Parental expertise in performing rectal washouts at home is ensured by our CNS team before and after PT.
Results
PT was completed in 69 of 74 HD patients. Rectal washouts were attempted on 63 patients before PT. Failure of rectal washout efficacy necessitated a stoma in four patients (6.4%).
Of the 65 patients who had PT and stoma closed, three (4.5%) required a further stoma over a mean follow-up period of 57 months (Range 7–144 months). Two of these had intractable diarrhoea due to Total Colonic Aganglionosis (TCA). One patient (1.5%) had unmanageable obstructive symptoms requiring re-diversion. Hirschsprung-associated enterocolitis (HAEC) requiring hospital admission occurred in 14 patients (21%).
Conclusion
Our stoma rates are lower compared to recent UK data. This could potentially be due to emphasis on parental ability to perform effective rectal washouts at home under CNS supervision.