The use of postoperative calibrations in Hirschsprung disease: a practice to reconsider?
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In brief
In brief
This prospective study challenges routine postoperative anal dilations after endorectal pull-through for Hirschsprung disease, finding that a non-dilation protocol does not increase anastomotic complications and may reduce enterocolitis and constipation rates. The findings suggest daily dilations may be unnecessary and potentially harmful.
- Postoperative anal dilations after Hirschsprung pull-through may not be necessary to prevent anastomotic complications.
- A non-dilation protocol showed significantly lower rates of enterocolitis (p=0.03) and constipation (p=0.02) in infants.
- Daily anal dilations carry potential risks without clear evidence of benefit in preventing anastomotic stenosis.
- Avoiding routine dilations is feasible and may improve postoperative outcomes in transanal endorectal pull-through patients.
Written by the GCMD Library team from the article.
Abstract
Purpose
Daily postoperative anal dilations after endorectal pull-through for Hirschsprung disease (HD) are still considered a common practice. We analyzed the potential risks of this procedure and its effectiveness compared to a new internal protocol.
Methods
All infants (< 6 months of age) who underwent transanal endorectal pull-through between January 2021 and January 2023 were prospectively enrolled in a new postoperative protocol group without daily anal dilations (Group A) and compared (1:2 fashion) to those previously treated by postoperative anal dilations (Group B). Patients were matched for age and affected colonic tract. Patients with associated syndromes, extended total intestinal aganglionosis, and presence of enterostomy were excluded. Outcomes considered were: anastomotic complications (stenosis, disruption/leakage), incidence of enterocolitis, and constipation.
Results
Eleven patients were included in group A and compared to 22 matched patients (group B). There were no significant differences in the occurrence of anastomotic complications between the two groups. We found a lower incidence of enterocolitis and constipation among group A (p = 0.03 and p = 0.02, respectively).
Conclusion
A non-dilation strategy after endorectal pull-through could be a feasible alternative and does not significantly increase the risk of postoperative anastomotic complications. Moreover, some preliminary advantages such as lower enterocolitis rate and constipation should be further investigated.