Contemporary practice patterns in the surgical management of Hirschsprung's disease

Keckler, Scott J.; Yang, Jeannie C.; Fraser, Jason D.; Aguayo, Pablo; Ostlie, Daniel J.; Holcomb, George; Peter, Shawn D. St.

doi:10.1016/j.jpedsurg.2009.02.050

Cited by 48 publications

(41 citation statements)

References 13 publications

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“…14 Unlike series from other developed countries, 16 anorectal manometry does not play a role in the diagnosis of neonatal Hirschsprung's disease in Britain, perhaps reflecting concerns regarding its accuracy in this age group. 19 In common with other studies, 13,15,16 a transition from staged approach to wide acceptance of primary pullthrough for left-sided Hirschsprung's disease has occurred in the UK over the last decade, with only six of 40 surgeons routinely performing stomas in the well neonate. Surgeons are more comfortable operating on cases at a younger age and smaller body weight and there has been convergence in the management of left-sided colonic Hirschsprung's disease into two predominant operative strategies: primary Soave-Boley and Duhamel techniques.…”

Section: Discussionmentioning

confidence: 77%

“…In the US, there has been a move away from the Duhamel pull-through. 13 We cannot ascertain from our data whether the continued popularity of the Duhamel pull-through in the UK is region-specific or whether surgeons within the same institution routinely employ different approaches. Continued exposure to this technique is potentially useful as it is a popular approach in revisional surgery, 20 and most respondents in this survey utilise this technique in right sided/total colonic disease.…”

Section: Discussionmentioning

confidence: 90%

“…The presented survey, like those conducted in US, 13,14 Japan 15,16 and Australia, 17 are limited by an inability to relate practice to clinical outcome, but do identify trends in management, highlight local and national variations in practice, promote discussion regarding the optimal approach to managing Hirschsprung's disease and suggest future areas of research.…”

Section: Discussionmentioning

confidence: 99%

“…There is little comparative data in the literature regarding the management of right-sided or total colonic aganglionosis, as previous studies have not analysed operative strategies according to the level of aganglionosis. [13][14][15][16][17] In 1998, 10 of 63 surgeons stated they would 'consider' using laparoscopy in Hirschsprung's disease. 7 Eighteen of 40 surgeons now use laparoscopy for colonic mobilisation or biopsies.…”

Section: Discussionmentioning

confidence: 99%

“…Similar trends toward avoiding a laparotomy wound have been reported elsewhere. 13,16 Where these studies differ, however, is in the proportion of surgeons utilising a purely transanal approach to rectosigmoid Hirschsprung's disease, with 29% of surgeons in Japan 16 and 38% in the US 13 employing an exclusively transanal approach, compared to three of 40 surgeons in the UK.…”

Section: Discussionmentioning

confidence: 99%

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Evolution in the management of Hirschsprung’s disease in the UK and Ireland: a national survey of practice revisited

Bradnock

Walker

2011

annals

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INTRODUCTION The management of Hirschsprung’s disease continues to evolve. This questionnaire survey aimed to determine current surgical management strategies for Hirschsprung’s disease in Britain. SUBJECTS AND METHODS The survey was sent electronically to all British paediatric surgeons. Initial questions explored individual experience and regional service provision. Additional questions, reserved for surgeons who perform definitive Hirschsprung’s disease surgery, addressed specific clinical scenarios. RESULTS Surveys were sent to 142 surgeons yielding 85 responses. After exclusions, 64 surveys from 21 centres were analysed. Forty-seven respondents worked in centres with designated ‘Hirschsprung’s disease surgeons’. Forty respondents perform definitive Hirschsprung’s disease surgery. In a well neonate with left-sided Hirschsprung’s disease, 34 of 40 surgeons favour primary pull-through following bowel decompression with rectal washouts; 35 of 40 surgeons aim to perform definitive surgery at less than 3 months of age, with 17 favouring laparoscopic-assisted Soave–Boley and 15 favouring an open Duhamel pull-through. Of the 40 surgeons, 36 use a staged approach to right-sided/total colonic Hirschsprung’s disease with 23 favouring a Duhamel or Long Duhamel pull-through. CONCLUSIONS The primary pull-through, using an open Duhamel or laparoscopic-assisted Soave–Boley technique, during the first 3 months of life, has become the operative strategy of choice in rectosigmoid Hirschsprung’s disease in Britain. Marked variation in practice remains for right-sided Hirschsprung’s disease.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Evolution in the management of Hirschsprung’s disease in the UK and Ireland: a national survey of practice revisited

Bradnock

Walker

2011

annals

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Clinical relevance of inflammation on rectal biopsy for Hirschsprung disease: An outcomes analysis

Lotakis,

Rubalcava,

Lopyan

et al. 2023

J. pediatr. gastroenterol. nutr.

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ObjectivesInflammation on diagnostic rectal biopsy for children with suspected Hirschsprung disease (HSCR) is reported on pathology, and its significance is unknown. We describe the management and outcomes of a cohort with inflammation on rectal biopsy compared to those without. Specifically, to address the hypothesis that inflammation on diagnostic biopsy is associated with increased complication rates irrespective of intervention type and timing.MethodsA single institution retrospective review of children with HSCR who underwent biopsy and endorectal pull‐through (ERPT) from 2010 to 2020 was performed. The primary outcome was overall complications at 30‐days following ERPT. Secondary outcomes included timing and type of operative intervention as well as postoperative enterocolitis diagnosed within 6‐months of ERPT.ResultsForty‐nine children were identified; inflammation was present on diagnostic biopsy for 17 children. Those with inflammation were more likely to have clinical evidence of enterocolitis at the time of biopsy (p = 0.001) and were more likely to undergo leveling colostomy before ERPT (p = 0.01). Children with inflammation had a higher anastomotic leak rate (p = 0.04). Subgroup analysis of patients with inflammation undergoing primary ERPT versus leveling colostomy demonstrated no significant difference in outcomes following definitive ERPT.ConclusionsOur study suggests inflammation on diagnostic rectal biopsy for HSCR is associated with increased anastomotic leak rates. While additional prospective studies are indicated, attention to methods of mitigating inflammation and confirming its resolution before definitive pull‐through may be of benefit for improving clinical outcomes in patients found with inflammation on diagnostic rectal biopsy.

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Laparoscopic-Assisted Pull-Through for Hirschsprung’s Disease

Cheek

Salesi

Scholz

2016

The SAGES Manual of Pediatric Minimally Invasive Surgery

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Contemporary practice patterns in the surgical management of Hirschsprung's disease

Cited by 48 publications

References 13 publications

Evolution in the management of Hirschsprung’s disease in the UK and Ireland: a national survey of practice revisited

Evolution in the management of Hirschsprung’s disease in the UK and Ireland: a national survey of practice revisited

Clinical relevance of inflammation on rectal biopsy for Hirschsprung disease: An outcomes analysis

Laparoscopic-Assisted Pull-Through for Hirschsprung’s Disease

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