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International Journal of Colorectal Disease

, Volume 34, Issue 2, pp 255–259 | Cite as

Optimal time for single-stage pull-through colectomy in infants with short-segment Hirschsprung disease

  • Tianqi Zhu
  • Xiaoyi Sun
  • Mingfa Wei
  • Bin Yi
  • Xiang Zhao
  • Wenjing Wang
  • Jiexiong FengEmail author
Original Article
  • 92 Downloads

Abstract

Objective

Short-segment Hirschsprung disease (HSCR) is the predominant type of HSCR that affects approximately 75% of patients. Whether single-stage endorectal pull-through (ERPT) surgery is appropriate for neonatal patients with HSCR has not been definitively determined. This retrospective cohort study concerning infants with short-segment HSCR investigated the optimal age for single-stage ERPT surgery, regardless of the operative approach.

Methods

The 198 patients were stratified by operative age ≤ 3 or > 3 months (groups A or B, respectively, n = 62 and 136, respectively). Diagnoses of short-segment HSCR were conducted by preoperative contrast enema and rectal suction biopsy with acetylcholinesterase immunohistochemical staining. The perioperative clinical course for all patients was reviewed and the accuracy rate of the preoperative diagnoses and postoperative short- and midterm outcomes were assessed.

Results

The rates of diagnostic accuracy, according to the results of the preoperative contrast enema or rectal suction biopsy, were lower in group A (67.2 and 93.5%, respectively) than in group B (81.4 and 94.9%, respectively). In groups A and B, 49 (79.1%) and 108 (79.4%) infants, respectively, completed follow-up examinations. The short-term outcomes were postoperative HSCR-associated enterocolitis, adhesive bowel obstruction, anastomosis leakage, and anal stenosis during the first 12 months after surgery. The midterm outcomes were incontinence and constipation at ~24 months after surgery. Compared with group B, group A experienced more incidences of anastomotic leakage in the short-term and more soiling in the midterm. In groups A and B, the rates of constipation recurrence were nil and 1.9%, respectively.

Conclusion

Infants with HSCR ≤3 months old at the time of single-stage ERPT surgery showed lower rates of accurate and conclusive diagnostic results and poorer postoperative outcomes. Waiting to perform this surgery until infants are older might be more beneficial.

Keywords

Short-segment Hirschsprung disease Infants Colectomy Enterocolitis 

Notes

Funding information

This study was supported by Grants from the National Natural Science Foundation of China (No. 81700448).

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Tianqi Zhu
    • 1
  • Xiaoyi Sun
    • 1
  • Mingfa Wei
    • 1
  • Bin Yi
    • 1
  • Xiang Zhao
    • 1
  • Wenjing Wang
    • 1
  • Jiexiong Feng
    • 1
    Email author
  1. 1.Department of Pediatric Surgery, Tongji HospitalHuazhong University of Science and TechnologyWuhanChina

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