Neonatal Surgery Unit, Bambino Gesù Children's Hospital, IRCCS, Piazza S Onofrio 4, 00165, Rome, Italy.
Division of Neuro-Urology, Bambino Gesu' Children's Hospital, IRCCS, Piazza di Sant'Onofrio 4, 00165, Rome, RM, Italy.
Pediatr Surg Int. 2024 Jul 5;40(1):176. doi: 10.1007/s00383-024-05761-6.
Daily postoperative anal dilations after endorectal pull-through for Hirschsprung disease (HD) are still considered a common practice. We analyzed the potential risks of this procedure and its effectiveness compared to a new internal protocol.
All infants (< 6 months of age) who underwent transanal endorectal pull-through between January 2021 and January 2023 were prospectively enrolled in a new postoperative protocol group without daily anal dilations (Group A) and compared (1:2 fashion) to those previously treated by postoperative anal dilations (Group B). Patients were matched for age and affected colonic tract. Patients with associated syndromes, extended total intestinal aganglionosis, and presence of enterostomy were excluded. Outcomes considered were: anastomotic complications (stenosis, disruption/leakage), incidence of enterocolitis, and constipation.
Eleven patients were included in group A and compared to 22 matched patients (group B). There were no significant differences in the occurrence of anastomotic complications between the two groups. We found a lower incidence of enterocolitis and constipation among group A (p = 0.03 and p = 0.02, respectively).
A non-dilation strategy after endorectal pull-through could be a feasible alternative and does not significantly increase the risk of postoperative anastomotic complications. Moreover, some preliminary advantages such as lower enterocolitis rate and constipation should be further investigated.
先天性巨结肠根治术后行每日直肠内肛门扩张术仍被认为是一种常规操作。我们分析了该操作的潜在风险及其与新的内部方案相比的有效性。
所有于 2021 年 1 月至 2023 年 1 月期间接受经肛门直肠内拖出术的婴儿（<6 个月）均前瞻性纳入新的术后方案组（无每日肛门扩张组，A 组），并与之前接受术后肛门扩张的患者（B 组）进行比较（1:2 比例）。对患者进行年龄和受累结肠段匹配。排除合并综合征、全肠神经节细胞发育不良、存在肠造口术的患者。考虑的结果为：吻合口并发症（狭窄、破裂/渗漏）、肠炎发生率和便秘。
A 组纳入 11 例患者，并与 22 例匹配患者（B 组）进行比较。两组间吻合口并发症的发生无显著差异。A 组肠炎和便秘的发生率较低（p=0.03 和 p=0.02）。
直肠内拖出术后不进行扩张策略可能是一种可行的替代方案，并且不会显著增加术后吻合口并发症的风险。此外，还应进一步研究较低的肠炎发生率和便秘等一些初步优势。
