Older age at diagnosis of Hirschsprung disease decreases risk of postoperative enterocolitis, but resection of additional ganglionated bowel does not.

Autor: Haricharan RN; Division of Pediatric Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA., Seo JM, Kelly DR, Mroczek-Musulman EC, Aprahamian CJ, Morgan TL, Georgeson KE, Harmon CM, Saito JM, Barnhart DC
Jazyk: angličtina
Zdroj: Journal of pediatric surgery [J Pediatr Surg] 2008 Jun; Vol. 43 (6), pp. 1115-23.
DOI: 10.1016/j.jpedsurg.2008.02.039
Abstrakt: 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.
Databáze: MEDLINE
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