From
StayCurrentMD
Hirschsprung Dilations, Gastroschisis Management, and CDH Volume Outcomes
With Dr. Alex Halpern · hosted by Dr. Em Gootee & Lizzy Lee, PA-C & Dr. Cecilia Gigena
Chapter 1 of 3
Hirschsprung dilations
Postoperative Dilations in Hirschsprung Disease
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Host summaries · secondary, not cited in answers
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
The prospective study by Beotti et al. 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 examined were anastomotic complications, enterocolitis, and constipation.
There was no significant difference in anastomotic complications between the two groups.
The non-dilation group had less enterocolitis and less constipation compared to the traditional dilation group.
Choosing not to do postoperative anal dilations may be a good alternative with benefits like lower constipation and enterocolitis.
For gastroschisis, delivery after 37 weeks is optimal.
Prophylactic antibiotics covering skin flora are adequate to reduce infection risk until closure in gastroschisis.
Studies support primary fascial repair for gastroschisis as long as hemodynamics and abdominal domain permit.
Sutureless repair for gastroschisis is safe and effective and does not delay feeding or increase length of stay.
There is a need for high quality randomized controlled trials to help provide evidence-based care for gastroschisis infants.
The CDH study by Pier et al. is a retrospective study done in Texas using a state hospital database examining outcomes by center volume.
The CDH study identified 1,314 patients: 728 from high volume centers, 9 from mid-volume centers, and 79 from low volume centers.
High volume centers had significantly lower mortality rates for CDH patients even though they treated significantly sicker patients.
High volume centers had significantly shorter length of stay for CDH patients.
High volume centers had better outcomes for patients with CDH.