Older age at diagnosis of Hirschsprung disease decreases risk of postoperative enterocolitis, but resection of additional ganglionated bowel does not
- Authors
- Haricharan, RN[Haricharan, Ramanath N.]; Seo, JM[Seo, Jeong-Meen]; Kelly, DR[Kelly, David R.]; Mroczek-Musulman, EC[Mroczek-Musulman, Elizabeth C.]; Aprahamian, CJ[Aprahamian, Charles J.]; Morgan, TL[Morgan, Traci L.]; Georgeson, KE[Georgeson, Keith E.]; Harmon, CM[Harmon, Carroll M.]; Saito, JM[Saito, Jacqueline M.]; Barnhart, DC[Barnhart, Douglas C.]
- Issue Date
- Jun-2008
- Publisher
- W B SAUNDERS CO-ELSEVIER INC
- Keywords
- Hirschsprung disease; enterocolitis; endorectal pull-through; postoperative complications; risk factors; ganglionated bowel; children
- Citation
- JOURNAL OF PEDIATRIC SURGERY, v.43, no.6, pp.1115 - 1123
- Indexed
- SCIE
SCOPUS
- Journal Title
- JOURNAL OF PEDIATRIC SURGERY
- Volume
- 43
- Number
- 6
- Start Page
- 1115
- End Page
- 1123
- URI
- https://scholarworks.bwise.kr/skku/handle/2021.sw.skku/81307
- DOI
- 10.1016/j.jpedsurg.2008.02.039
- ISSN
- 0022-3468
- Abstract
- Purpose: This study was conducted to determine the effect of age at diagnosis and length of ganglionated bowel resected on postoperative Hirschsprung-associated enterocolitis (HAEC). Methods: Children who underwent endorectal pull-through (ERPT) between January 1993 and December 2004 were retrospectively reviewed. t Test, analysis of variance, Kaplan-Meier, and Cox's proportional hazards analyses were performed. Results: Fifty-two children with Hirschsprung disease (median age, 25 days; range, 2 days-16 years) were included. Nineteen (37%) had admissions for HAEC. Proportional hazards regression showed that HAEC admissions decreased by 30% with each doubling of age at diagnosis (P = .03) and increased 9-fold when postoperative stricture was present (P < .01), after controlling for type of ERPT, trisomy 21, transition zone level, and preoperative enterocolitis. Thirty-six children, with age at initial operation less than 6 months, were grouped based on length of ganglionated bowel excised (A [5 cm] and B [>5 cm]). No significant difference in the number of HAEC admissions during initial 2 years post-ERPT was seen between groups A (n = 18) and B (n = 18). The study had a power of 0.8 to detect a difference of 1 admission over 2 years. Conclusions: Children diagnosed with Hirschsprung disease at younger ages are at a greater risk for postoperative enterocolitis. Excising a longer margin of ganglionated bowel (>5 cm) does not seem to be beneficial in decreasing HAEC admissions. (C) 2008 Elsevier Inc. All rights reserved.
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