Postoperative Hirschsprung's enterocolitis after minimally invasive Swenson's procedure

Ravinder Singh, Brian H. Cameron, Johnathan M. Walton, Forough Farrokhyar, Steven H. Borenstein, Peter G. Fitzgerald

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

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 languageEnglish (US)
Pages (from-to)885-889
Number of pages5
JournalJournal of Pediatric Surgery
Volume42
Issue number5
DOIs
StatePublished - Jul 1 2007
Externally publishedYes

Keywords

  • Enterocolitis
  • Hirschsprung's disease
  • Laparoscopic
  • Transanal

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

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