The use of postoperative calibrations in Hirschsprung disease
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Federico Beati, Tommaso D'Angelo, Chiara Iacusso, Barbara Daniela Iacobelli, Federico Scorletti, Laura Valfré, Chiara Pellegrino, Pietro Bagolan, Andrea Conforti, Fabio Fusaro.
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.
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For patients with Hirschsprung disease who undergo endorectal pull-through surgeries, are daily postoperative anal dilations necessary and effective? I'm Lizzie Lee from Cincinnati Children's Hospital, and this is an article you should know about. This prospective study took place 2021 to 2023 and included 33 patients under six months old who underwent endorectal pull-through surgeries. Patients were assigned to a new non-dilation protocol group or a traditional dilation group. The primary outcomes they looked at were anastomotic complications, enterocolitis, and constipation. But what did they find? There was no significant difference in anastomotic complications between the two groups, but the non-dilation group had less enterocolitis and less constipation. This means that choosing not to do postoperative anal dilations may be a good alternative with benefits like lower constipation and enterocolitis. Let us know what you think in the comments below and stay tuned for more articles that you should know about.