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Oral Presentation - 42
The PODCAST-Question: PostOperative Dilation versus Calibration After Surgical Treatment of Hirschsprung's disease – what is necessary?
Daniel Keese 1, Florian Friedmacher 2, Udo Rolle 2, Hannah Neeser 1, Tim Gerwinn 1, Sasha Tharakan 1, Ueli Möhrlen 1
1 Children's University Hospital of Zurich, Switzerland
2 Department of Pediatric Surgery and Pediatric Urology, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt, Germany
Purpose:
Postoperative anal dilations following surgery for Hirschsprung disease (HD) remains a common practice. Our aim was to critically evaluate the benefit of routine dilation between groups who received either continuous anal dilations or a single postoperative calibration.
Methods:
Patients who underwent surgery for HD at the University Children's Hospital Zurich (Switzerland) or the University Hospital Frankfurt am Main (Germany) within the first year of life were reviewed. The two cohorts were compared regarding anal dilation performed routinely (PD) or as a single postoperative calibration (PC). The primary outcomes were the development of anastomotic stricture, Hirschsprung-associated enterocolitis (HAEC) and constipation / fecal incontinence.
Results:
A total of 91 patients were included in this study, with 46 patients (51%) in the PD group with regular postoperative anal dilation and 45 (49%) in the PC group with a single postoperative calibration. Anorectal stricture was noted in 5 patients (10.9%) in the PD group and in 9 patients (20%) in the PC group (p=0.259). Regarding the incidence of HAEC 5 children (10.9%) of the PD group and 6 children (13.3%) of the PC group developed HAEC (p=0.718) postoperatively. The constipation / fecal incontinence rates were similar with 14 patients (32.6%) in the PC group and 16 patients (34.8%) in the PD group (p=0.67).
Conclusion:
Regular postoperative anal dilation after HD surgery does not reduce the rates of postoperative stricture and HAEC as well as constipation / fecal incontinence. A single postoperative calibration is sufficient to decide whether further regular dilations are necessary.