Maggie L Westfal1, Ongoly Okiemy2, Patrick Ho Yu Chung3, Jiexiong Feng4, Changgui Lu5, Go Miyano6, Paul Kwong Hang Tam3, Weibing Tang5, Kenneth Kak Yuen Wong3, Atsuyuki Yamataka6, Richard A Guyer1, Daniel P Doody1, Allan M Goldstein7. 1. Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Warren 1151, Boston, Massachusetts MA 02114, United States. 2. Department of Pediatric Surgery, American Memorial Hospital, Reims-Champagne-Ardennes University, Reims, France. 3. Division of Pediatric Surgery, Queen Mary Hospital, Hong Kong, China. 4. Department of Pediatric Surgery, Tongji Hospital, Wuhan, China. 5. Department of Pediatric Surgery, Children's Hospital Affiliated to Nanjing Medical University, Nanjing, China. 6. Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan. 7. Department of Pediatric Surgery, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Warren 1151, Boston, Massachusetts MA 02114, United States. Electronic address: agoldstein@partners.org.
Abstract
BACKGROUND: The optimal age for endorectal pull-through (ERPT) surgery in infants with short-segment Hirschsprung disease varies, with a trend toward earlier surgery. However, it is unclear if the timing of surgery impacts functional outcomes. We undertook the present study to determine the optimal timing of ERPT in infants with short-segment Hirschsprung disease. METHODS: The NCBI PubMed database was searched for English-language manuscripts published between 2000 and 2019 analyzing functional outcomes for patient following the initial Soave ERPT for short-segment Hirschsprung disease. Raw data from these studies was obtained from the corresponding author for each manuscript. We combined data from these papers with our own institutional data and performed a meta-analysis. RESULTS: A total of 780 infants were included in our meta-analysis. Constipation occurred in 1.0-31.7%, soiling 1.3-26.0%, anastomotic stricture 0.0-14.6%, and anastomotic leak 0.0-3.4%. Regarding age at ERPT, younger infants at the time of initial corrective surgery had higher rates of soiling, stricture, and leak. On sub-group analysis, patients <2.5 months at their initial corrective surgery had higher rates of soiling (25.9% vs. 11.4%, p<0.01), as well as stricture (10.0% vs 1.7%, p<0.01) and leak (5.5% vs 1.3%, p<0.01). CONCLUSION: While age at Soave endorectal pull-through for short-segment Hirschsprung disease has decreased over time, functional outcomes associated with this trend have only recently been examined. Our findings suggest that patients <2.5 months old at the time of endorectal pull-through may have worse functional outcomes, emphasizing the need to consider further study of the timing of surgery in this population.
BACKGROUND: The optimal age for endorectal pull-through (ERPT) surgery in infants with short-segment Hirschsprung disease varies, with a trend toward earlier surgery. However, it is unclear if the timing of surgery impacts functional outcomes. We undertook the present study to determine the optimal timing of ERPT in infants with short-segment Hirschsprung disease. METHODS: The NCBI PubMed database was searched for English-language manuscripts published between 2000 and 2019 analyzing functional outcomes for patient following the initial Soave ERPT for short-segment Hirschsprung disease. Raw data from these studies was obtained from the corresponding author for each manuscript. We combined data from these papers with our own institutional data and performed a meta-analysis. RESULTS: A total of 780 infants were included in our meta-analysis. Constipation occurred in 1.0-31.7%, soiling 1.3-26.0%, anastomotic stricture 0.0-14.6%, and anastomotic leak 0.0-3.4%. Regarding age at ERPT, younger infants at the time of initial corrective surgery had higher rates of soiling, stricture, and leak. On sub-group analysis, patients <2.5 months at their initial corrective surgery had higher rates of soiling (25.9% vs. 11.4%, p<0.01), as well as stricture (10.0% vs 1.7%, p<0.01) and leak (5.5% vs 1.3%, p<0.01). CONCLUSION: While age at Soave endorectal pull-through for short-segment Hirschsprung disease has decreased over time, functional outcomes associated with this trend have only recently been examined. Our findings suggest that patients <2.5 months old at the time of endorectal pull-through may have worse functional outcomes, emphasizing the need to consider further study of the timing of surgery in this population.
Authors: Patrick Ho Yu Chung; Kenneth Kak Yuen Wong; Paul Kwong Hang Tam; Michael Wai Yip Leung; Nicholas Sih Yin Chao; Kelvin Kam Wing Liu; Edwin Kin Wai Chan; Yuk Him Tam; Kim Hung Lee Journal: Pediatr Surg Int Date: 2017-10-26 Impact factor: 1.827