Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Primary Children's Hospital, 100N. Mario Cappecchi Dr., Suite 3800, Salt Lake City, UT 84113, United States.
Division of Pediatric Surgery, Department of Surgery, University of Utah School of Medicine, Primary Children's Hospital, 100N. Mario Cappecchi Dr., Suite 3800, Salt Lake City, UT 84113, United States.
J Pediatr Surg. 2021 Aug;56(8):1465-1469. doi: 10.1016/j.jpedsurg.2021.04.024. Epub 2021 Apr 30.
BACKGROUND/PURPOSE: the timing of endorectal pull-through for Hirschsprung disease (HD) is controversial. Neonatal primary endorectal pull-through theoretically prevents preoperative enterocolitis. Delayed primary endorectal pull-through offers the surgeon the benefit of more robust perineal anatomy and allows primary caregivers the time to emotionally process the diagnosis and to gain experience with rectal irrigations. We hypothesized that delayed primary endorectal pull-through would be associated with equivalent perioperative morbidity compared to the neonatal repair and would lead to improved long-term functional outcomes.
we analyzed all patients in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) registry who had a primary endorectal pull-through for HD and at least three-and-one-half years of follow up in a specialty colorectal clinic. We evaluated patient demographics, operative outcomes, perioperative episodes of enterocolitis, and long-term functional outcomes for the neonatal (<31 days) and delayed (≥31 days) pull-through cohorts.
eighty-two patients were identified of whom 49 were operated upon in the neonatal period and 33 in a delayed fashion. The median age at operation was 11 days [IQR 7 - 19 days] for the neonatal cohort and 98 days [IQR 61 - 188 days] for the delayed cohort. Thirty-four (69.4%) of the neonatal and 22 (66.7%) of the delayed cohort patients had rectosigmoid transition zones. Four of 49 patients (8.1%) in the neonatal cohort were diagnosed with enterocolitis preoperatively compared to two of 33 (6.0%) in the delayed cohort (p = 0.89). Eighteen of 49 patients (36.7%) in the neonatal cohort and 16 of 33 (48.5%) in the delayed cohort had at least one postoperative episode of enterocolitis (p = 0.38). Fifteen of 49 patients (30.6%) in the neonatal cohort were receiving bowel management for fecal incontinence at most recent follow up compared to five of 33 (15.2%) in the delayed cohort (p = 0.13).
delayed primary endorectal pull-through offers a safe alternative to operation in the neonatal period and appears to have, at least, equivalent functional outcomes.
Level III, retrospective comparative study.
背景/目的：先天性巨结肠（HD）的经肛门内拖出术时机存在争议。新生儿期行原发性经肛门内拖出术理论上可预防术前肠炎。延迟行原发性经肛门内拖出术可为外科医生提供更健壮的会阴解剖结构优势，并使主要照护者有时间在情感上接受诊断，并获得直肠灌洗经验。我们假设，与新生儿修复相比，延迟行原发性经肛门内拖出术将与同等的围手术期发病率相关，并将导致改善的长期功能结局。
我们分析了在小儿肛肠和骨盆学习联盟（PCPLC）注册中心接受原发性经肛门内拖出术治疗 HD 并在专业肛肠诊所接受至少 3 年半随访的所有患者。我们评估了患者的人口统计学特征、手术结果、围手术期肠炎发作以及新生儿（<31 天）和延迟（≥31 天）拖出组的长期功能结局。
共确定了 82 例患者，其中 49 例在新生儿期手术，33 例延迟手术。新生儿组的中位手术年龄为 11 天[IQR 7-19 天]，延迟组为 98 天[IQR 61-188 天]。34 例（69.4%）新生儿组和 22 例（66.7%）延迟组患者的直肠乙状结肠移行区。与延迟组的 2 例（6.0%）相比，新生儿组的 4 例（8.1%）患者在术前被诊断为肠炎（p=0.89）。新生儿组的 18 例（36.7%）和延迟组的 16 例（48.5%）患者至少有一次术后肠炎发作（p=0.38）。新生儿组的 15 例（30.6%）患者在最近的随访中因大便失禁接受了肠道管理，而延迟组的 5 例（15.2%）患者接受了肠道管理（p=0.13）。
延迟行原发性经肛门内拖出术是新生儿期手术的一种安全替代方法，并且似乎至少具有同等的功能结局。
III 级，回顾性比较研究。
