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Impact of Colorectal Nurse Specialist supervised parental administration of rectal washouts on Hirschsprung’s disease outcomes: a retrospective review

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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.

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Data availability

The data that support the findings of this study are available on request from the corresponding author.

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Authors and Affiliations

  1. Department of Paediatric Surgery, Leicester Royal Infirmary (LRI), Infirmary Square, Leicester, LE1 5WW, UK

    Debasish B. Banerjee, Nalini Appasawmy, Stephen Caldwell, Rachel L. Wade, Anthony Owen, Nitin Patwardhan & Bala Eradi

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  1. Debasish B. Banerjee
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  2. Nalini Appasawmy
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  3. Stephen Caldwell
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  4. Rachel L. Wade
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  5. Anthony Owen
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  7. Bala Eradi
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Contributions

DBB and NA collected the data , patients' clinical, operative and follow up details were contributed by RLW,SC,AO,NP and BE, BE analysed the data and wrote the manuscript. DBB collected the references and wrote part of the manuscript.

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Correspondence to Bala Eradi.

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Banerjee, D.B., Appasawmy, N., Caldwell, S. et al. Impact of Colorectal Nurse Specialist supervised parental administration of rectal washouts on Hirschsprung’s disease outcomes: a retrospective review. Pediatr Surg Int 40, 107 (2024). https://doi.org/10.1007/s00383-024-05687-z

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