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Prognostic factors of postoperative Hirschsprung-associated enterocolitis: a cohort study

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Abstract

Purpose

To identify prognostic factors of postoperative Hirschsprung-associated enterocolitis (HAEC).

Method

A retrospective cohort study of Hirschsprung patients between 2006 and 2021 was conducted. Patients with anorectal malformation and non-definitive surgery were excluded. Associated factors for postoperative HAEC were reported with hazard ratio (HR) and 95% confidence interval (CI).

Results

Forty-nine patients were excluded due to concurrent anorectal malformation and incomplete data. Of 274 patients, 75 patients (27.4%) had at least one episode of postoperative HAEC. There were 28 patients (37.3%) who had multi-episodes of HAEC. The total episodes of post-operative HAEC in this study were 121 episodes (36.8%). In multivariable survival analysis, significant factors associated with postoperative HAEC were the aganglionic level above sigmoid colon (HR = 3.47, p = 0.023, 95% CI 1.19–10.09), and total colonic aganglionosis (HR = 14.83, p = 0.004, 95% CI 2.33–94.40). The patients who experienced clinical enterocolitis before 2 weeks after surgery significantly developed more postoperative HAEC (HR = 5.32, p = 0.038, % CI 1.09–25.92). The incidence of postoperative HAEC was increase in patients with postoperative obstructive symptoms (48.0%). One patient died due to severe sepsis from postoperative HAEC, while three others required intensive care.

Conclusions

The long involvement of aganglionic segment and early postoperative HAEC was significantly associated with postoperative HAEC. Frequent follow-up, parental education, and early treatment are recommended in these individuals, particularly in the first year after surgery.

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Data availability

The datasets used during the current study are available from the first and corresponding authors on reasonable request.

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Acknowledgements

The authors acknowledge the Clinical Surgical Research Center, Department of Surgery, Faculty of Medicine, Chiang Mai University, and the Faculty of Medicine, Chiang Mai University Chiang Mai, Thailand, who supported the research conduction and fund.

Funding

This research was funded by the Faculty of Medicine, Chiang Mai University Hospital.

Author information

Authors and Affiliations

  1. Division of Pediatric Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University Hospital Clinical Surgical Research Center, 110 Intavaroros Road, Muang Chiang Mai District, Chiang Mai, 50200, Thailand

    Sireekarn Chantakhow, Kanokkan Tepmalai, Jesda Singhavejsakul & Jiraporn Khorana

  2. Faculty of Medicine, Clinical Surgical Research Center, Chiang Mai University, Chiang Mai, Thailand

    Sireekarn Chantakhow, Kanokkan Tepmalai, Jesda Singhavejsakul, Apichat Tantraworasin & Jiraporn Khorana

  3. Faculty of Medicine, Clinical Epidemiology and Statistical Statistic Center, Chiang Mai University, Chiang Mai, Thailand

    Apichat Tantraworasin & Jiraporn Khorana

  4. Division of Thoracic Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

    Apichat Tantraworasin

Authors
  1. Sireekarn Chantakhow
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Contributions

Conceptualization, J.K. and S.C.; methodology, J.K. and S.C.; software, S.C.; validation, J.K. and S.C..; formal analysis, J.K. and S.C.; data curation, S.C.; writing—original draft preparation, S.C.; writing—review and editing, J.K.; supervision, J.K., J.S., K.T. and A.T.; project administration, J.K.; funding acquisition, J.K. and S.C. All authors have read and agreed to the published version of the manuscript.

Corresponding author

Correspondence to Jiraporn Khorana.

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“Part of this study was chosen to present as poster presentation in 68th Annual International BAPS Congress for 2022 (British Association of Pediatric Surgeon); meeting 13-15th July 2022.”

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Chantakhow, S., Tepmalai, K., Singhavejsakul, J. et al. Prognostic factors of postoperative Hirschsprung-associated enterocolitis: a cohort study. Pediatr Surg Int 39, 77 (2023). https://doi.org/10.1007/s00383-023-05364-7

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