Abstract
Background/Purpose: Our preferred minimally invasive technique of Swenson's procedure has evolved from laparoscopic (LapSwen) to Swenson's transanal pullthrough (SWAP). We studied the incidence of postoperative Hirschsprung's enterocolitis (HEC) over the past decade. Methods and Materials: We retrospectively reviewed the charts of 52 children who had a primary Swenson's pullthrough procedure between 1995 and 2006. Two cohorts (25 LapSwen [1995-2000] and 27 SWAP [1998-2006]) were compared. Results: Median ages of diagnosis were 13 days for LapSwen and 4 days for SWAP. Median age at surgery was 4.1 months for LapSwen and 3.3 months for SWAP. Postoperative HEC occurred in 12% (16% LapSwen, 7.4% SWAP). The incidence of Down's syndrome and preoperative HEC did not differ between the 2 cohorts. Three children with HEC were Clostridium difficile-positive. Long-term function in the 36 children older than 4 years was excellent in 22%, good in 50%, fair in 11% and poor in 17%. Conclusion: Our incidence of postoperative HEC is low, and we have seen a trend toward fewer cases after the SWAP procedure. Early diagnosis, preoperative rectal irrigations, and routine postoperative anal dilatation may be contributing to the elimination of HEC as a significant risk after surgery for Hirschsprung's disease.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 885-889 |
| Number of pages | 5 |
| Journal | Journal of Pediatric Surgery |
| Volume | 42 |
| Issue number | 5 |
| DOIs | |
| State | Published - Jul 2007 |
| Externally published | Yes |
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Keywords
- Enterocolitis
- Hirschsprung's disease
- Laparoscopic
- Transanal
ASJC Scopus subject areas
- Surgery
Cite this
Postoperative Hirschsprung's enterocolitis after minimally invasive Swenson's procedure. / Singh, Ravinder; Cameron, Brian H.; Walton, Johnathan M.; Farrokhyar, Forough; Borenstein, Steven H.; Fitzgerald, Peter G.
In: Journal of Pediatric Surgery, Vol. 42, No. 5, 07.2007, p. 885-889.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Postoperative Hirschsprung's enterocolitis after minimally invasive Swenson's procedure
AU - Singh, Ravinder
AU - Cameron, Brian H.
AU - Walton, Johnathan M.
AU - Farrokhyar, Forough
AU - Borenstein, Steven H.
AU - Fitzgerald, Peter G.
PY - 2007/7
Y1 - 2007/7
N2 - Background/Purpose: Our preferred minimally invasive technique of Swenson's procedure has evolved from laparoscopic (LapSwen) to Swenson's transanal pullthrough (SWAP). We studied the incidence of postoperative Hirschsprung's enterocolitis (HEC) over the past decade. Methods and Materials: We retrospectively reviewed the charts of 52 children who had a primary Swenson's pullthrough procedure between 1995 and 2006. Two cohorts (25 LapSwen [1995-2000] and 27 SWAP [1998-2006]) were compared. Results: Median ages of diagnosis were 13 days for LapSwen and 4 days for SWAP. Median age at surgery was 4.1 months for LapSwen and 3.3 months for SWAP. Postoperative HEC occurred in 12% (16% LapSwen, 7.4% SWAP). The incidence of Down's syndrome and preoperative HEC did not differ between the 2 cohorts. Three children with HEC were Clostridium difficile-positive. Long-term function in the 36 children older than 4 years was excellent in 22%, good in 50%, fair in 11% and poor in 17%. Conclusion: Our incidence of postoperative HEC is low, and we have seen a trend toward fewer cases after the SWAP procedure. Early diagnosis, preoperative rectal irrigations, and routine postoperative anal dilatation may be contributing to the elimination of HEC as a significant risk after surgery for Hirschsprung's disease.
AB - Background/Purpose: Our preferred minimally invasive technique of Swenson's procedure has evolved from laparoscopic (LapSwen) to Swenson's transanal pullthrough (SWAP). We studied the incidence of postoperative Hirschsprung's enterocolitis (HEC) over the past decade. Methods and Materials: We retrospectively reviewed the charts of 52 children who had a primary Swenson's pullthrough procedure between 1995 and 2006. Two cohorts (25 LapSwen [1995-2000] and 27 SWAP [1998-2006]) were compared. Results: Median ages of diagnosis were 13 days for LapSwen and 4 days for SWAP. Median age at surgery was 4.1 months for LapSwen and 3.3 months for SWAP. Postoperative HEC occurred in 12% (16% LapSwen, 7.4% SWAP). The incidence of Down's syndrome and preoperative HEC did not differ between the 2 cohorts. Three children with HEC were Clostridium difficile-positive. Long-term function in the 36 children older than 4 years was excellent in 22%, good in 50%, fair in 11% and poor in 17%. Conclusion: Our incidence of postoperative HEC is low, and we have seen a trend toward fewer cases after the SWAP procedure. Early diagnosis, preoperative rectal irrigations, and routine postoperative anal dilatation may be contributing to the elimination of HEC as a significant risk after surgery for Hirschsprung's disease.
KW - Enterocolitis
KW - Hirschsprung's disease
KW - Laparoscopic
KW - Transanal
UR - http://www.scopus.com/inward/record.url?scp=34248216640&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=34248216640&partnerID=8YFLogxK
U2 - 10.1016/j.jpedsurg.2006.12.055
DO - 10.1016/j.jpedsurg.2006.12.055
M3 - Article
VL - 42
SP - 885
EP - 889
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
SN - 0022-3468
IS - 5
ER -