Oblique vs. Circular Anastomosis in the Children Underwent Soave’s Pull-Through Surgery for the Treatment of Hirschsprung’s Disease: Which Is the Best?

Askarpour, Shahnam; Peyvasteh, Mehran; Droodchi, Gholamreza; Javaherizadeh, Hazhir

doi:10.1590/0102-672020200003e1545

Cited by 5 publications

(6 citation statements)

References 18 publications

(19 reference statements)

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“…In addition to the 31 factors analyzed in the present meta-analysis, a number of other factors are thought to be potentially associated with HAEC. For instance, oblique anastomosis 88 , distance of the ganglion site from the incision margin 89 , low IgA levels, low birth weight 82 , birth Apgar score 12 , and milk allergy 90 could be the risk factors for HAEC. HSCR complications are reportedly associated with other congenital malformations, maternal age older than 35 years, preterm birth 53 .…”

Section: Discussionmentioning

confidence: 99%

Risk factors for Hirschsprung disease-associated enterocolitis: a systematic review and meta-analysis

Zhang

Sun

et al. 2023

International Journal of Surgery

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Background: The incidence of Hirschsprung disease (HSCR) is nearly 1/5000 and patients with HSCR are usually treated through surgical intervention. Hirschsprung disease-associated enterocolitis (HAEC) is a complication of HSCR with the highest morbidity and mortality in patients. The evidence on the risk factors for HAEC remains inconclusive to date. Methods: Four English databases and four Chinese databases were searched for relevant studies published until May 2022. The search retrieved 53 relevant studies. The retrieved studies were scored on the Newcastle–Ottawa Scale by three researchers. Revman 5.4 software was employed for data synthesis and analysis. Stata 16 software was employed for sensitivity analysis and bias analysis. Results: A total of 53 articles were retrieved from the database search, which included 10 012 cases of HSCR and 2310 cases of HAEC. The systematic analysis revealed anastomotic stenosis or fistula [I 2=66%, risk ratio (RR)=1.90, 95% CI 1.34–2.68, P<0.001], preoperative enterocolitis (I 2=55%, RR=2.07, 95% CI 1.71–2.51, P<0.001), preoperative malnutrition (I 2=0%, RR=1.96, 95% CI 1.52–2.53, P<0.001), preoperative respiratory infection or pneumonia (I 2=0%, RR=2.37, 95% CI 1.91–2.93, P<0.001), postoperative ileus (I 2=17%, RR=2.41, 95% CI 2.02–2.87, P<0.001), length of ganglionless segment greater than 30 cm (I 2=0%, RR=3.64, 95% CI 2.43–5.48, P<0.001), preoperative hypoproteinemia (I 2=0%, RR=1.91, 95% CI 1.44–2.54, P<0.001), and Down syndrome (I 2=29%, RR=1.65, 95% CI 1.32–2.07, P<0.001) as the risk factors for postoperative HAEC. Short-segment HSCR (I 2=46%, RR=0.62, 95% CI 0.54–0.71, P<0.001) and transanal operation (I 2=78%, RR=0.56, 95% CI 0.33–0.96, P=0.03) were revealed as the protective factors against postoperative HAEC. Preoperative malnutrition (I 2=35 % , RR=5.33, 95% CI 2.68–10.60, P<0.001), preoperative hypoproteinemia (I 2=20%, RR=4.17, 95% CI 1.91–9.12, P<0.001), preoperative enterocolitis (I 2=45%, RR=3.51, 95% CI 2.54–4.84, P<0.001), and preoperative respiratory infection or pneumonia (I 2=0%, RR=7.20, 95% CI 4.00–12.94, P<0.001) were revealed as the risk factors for recurrent HAEC, while short-segment HSCR (I 2=0%, RR=0.40, 95% CI 0.21–0.76, P=0.005) was revealed as a protective factor against recurrent HAEC. Conclusion: The present review delineated the multiple risk factors for HAEC, which could assist in preventing the development of HAEC.

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Section: Discussionmentioning

confidence: 99%

Risk factors for Hirschsprung disease-associated enterocolitis: a systematic review and meta-analysis

Zhang

Sun

et al. 2023

International Journal of Surgery

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“…Regarding the surgical technique employed, the Rehbein procedure was used in 47.2% (n=76) of cases, whereas TEPT was utilized in 52.8% (n=85) of instances. The length of the aganglionic segment averaged 25 [20][21][22][23][24][25][26][27][28][29][30] aganglionic segment was as follows: ultrashort segment in 16.9% (n=27) of cases, rectosigmoid region in 47.5% (n=77), descending colon in 18.8% (n=30), splenic flexure in 12.5% (n=20), transverse colon in 3.7% (n=6), and ascending colon in 0.6% (n=1) of the cases. Preoperative enterocolitis was noted in 33.1% (n=53) of patients.…”

Section: Ethical Approvalmentioning

confidence: 99%

“…Other factors such as anastomosis technique, distance from the ganglion site to the incision margin, and low IgA levels have been suggested as potential risk factors for HAEC, though these were not analyzed in our study due to limited data [20][21][22][23]. Similarly, associations between HD complications with other congenital malformations, maternal age, and preterm birth are reported in the literature but could not be included in our analysis for the some reason.…”

Section: Figure 5 Correlation Graphmentioning

confidence: 99%

Predictor of Hirschsprung-associated enterocolitis: A regression analysis

Karaaslan,

Yazici,

Kuzdan

2024

j-ebr

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To identify independent predictors for Hirschsprung-associated enterocolitis (HAEC) through regression analysis of various clinical factors. Method: This retrospective study examined clinical, surgical, and diagnostic data of patients treated for Hirschsprung's disease (HD), evaluating the impact of various factors like aganglionic segment length and postoperative complications. Results: We analyzed data from 161 patients with HD. Surgical interventions were split between the Rehbein procedure at 47.2% (n=76) and transanal endorectal pull-through (TEPT) at 52,8% (n=85). The median age at diagnosis was 7 [3-12.5] months. The average length of the aganglionic segment measured 25 [20-30] cm distributed as follows: ultrashort segment (16.9%, n=27), rectosigmoid (47.5%, n=76), descending colon (18.8%, n=30), splenic flexure (12.5%, n=20), transverse colon (3.7%, n=6), and ascending colon (0.6%, n=1). Preoperative enterocolitis was observed in 33.1% (n=53). Postoperative enterocolitis occurred in 28.1% (n=45). Additional interventions included rectal botox injections (2.5%, n=4), myectomies (3.1%, n=5), and re-do surgeries (3.1%, n=5). Anastomotic strictures were noted in 5.6% (n=9) of the cases. Upon analyzing patients who presented with HAEC in the preoperative period, it was determined that the length of the aganglionic segment (p=0.001, OR: 1.07) and the age at diagnosis (p=0.003, OR: 1.03) were independent risk factors for HAEC. A positive correlation was found between Length of aganglionic segment and number of preoperative HAEC (p=0.002, r=0.405). Conclusion:In our study, it was observed that long-segment Hirschsprung's disease and a delayed age at diagnosis are risk factors for Hirschsprung-associated enterocolitis.

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“…Surgical complications, although rare, can occur and range from wound infections and anastomotic leaks to enterocolitis and obstructive symptoms. In a study by Askarpour et al, children who underwent Saove's pull-through procedure with oblique and circular anastomosis were followed up for soiling, and postoperative complications, such as wound infection, wound dehiscence, peritonitis, fecal soiling, and perianal excoriation, were recorded for each patient [ 17 ]. The study found that perianal excoriation was the most common complication among patients in both groups.…”

Section: Reviewmentioning

confidence: 99%

“…Also, enterocolitis was more frequent in the circular group than in the oblique group. The anastomotic stricture was also more frequent in the circular group [ 17 ]. Anorectal function generally improves with age.…”

Section: Reviewmentioning

confidence: 99%

Post-surgical Outcomes of Different Surgical Techniques in Hirschsprung’s Disease: A Literature Review

Munnangi,

Sayed Mushir Ali,

Deva

et al. 2023

Cureus

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Hirschsprung's disease (HD) is a rare condition that affects newborns and is characterized by the lack of ganglion cells in the colon. Typical symptoms include difficulty passing stool, vomiting, and trouble feeding. Various surgical methods are available to manage the condition. The aim of the study is to investigate and compare the post-surgical outcomes of different surgical techniques used in the treatment of HD. A thorough literature search was conducted using various electronic databases to identify relevant studies to be referred to. Double-blinded screening of the identified articles led to the final selection of 40 out of 440 HD, including transanal endorectal pull-through (TERPT), laparoscopic approaches, and modified techniques. Several studies have investigated surgical procedures for HD, including TERPT, laparoscopic methods, and modified techniques. These have shown positive outcomes, with fewer complications, improved bowel function, and favorable cosmetic results. Individual patient characteristics and surgeon expertise should guide procedure selection. Surgery for HD aims to restore normal bowel function, but post-surgical outcomes can include constipation or fecal incontinence. Complications like enterocolitis, anastomotic stricture, and sphincter damage may occur. Laparoscopic approaches have shorter hospital stays. However long-term follow-up is essential to assess quality of life, psychological well-being, and potential side effects.

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Oblique vs. Circular Anastomosis in the Children Underwent Soave’s Pull-Through Surgery for the Treatment of Hirschsprung’s Disease: Which Is the Best?

Cited by 5 publications

References 18 publications

Risk factors for Hirschsprung disease-associated enterocolitis: a systematic review and meta-analysis

Risk factors for Hirschsprung disease-associated enterocolitis: a systematic review and meta-analysis

Predictor of Hirschsprung-associated enterocolitis: A regression analysis

Post-surgical Outcomes of Different Surgical Techniques in Hirschsprung’s Disease: A Literature Review

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