Treatment of Persistent Soiling in Hirschsprung Disease With Antegrade Continence Enemas.

Autor: Xu T; Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia. Electronic address: toxu@childrensnational.org., Hanke R; Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia., Samuk I; Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia., Russell TL; Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia., Rana MS; Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia., Tiusaba L; Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia., Jacobs SE; Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia., Bokova E; Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia., Varda BK; Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia., Teeple E; Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia., Badillo AT; Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia., Levitt MA; Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia., Feng C; Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia.
Jazyk: angličtina
Zdroj: The Journal of surgical research [J Surg Res] 2024 Oct; Vol. 302, pp. 411-419. Date of Electronic Publication: 2024 Aug 16.
DOI: 10.1016/j.jss.2024.07.061
Abstrakt: Introduction: Patients with Hirschsprung disease (HD) can experience soiling after their pull-through. We evaluated the use of antegrade continence enema (ACE) for this patient population and investigated the timing and factors associated with getting the patient clean.
Methods: We performed a single-institution retrospective review (from January 2020 to January 2023) of patients with HD and prior pull-through who had persistent soiling, failed laxative treatment or rectal enemas, and were treated with antegrade enemas. The primary outcome was time to become "clean of stool" which was defined as at least one bowel movement per day, no more than one stool accident per week, and no significant stool burden radiographically. Kaplan-Meier survival analysis was performed, and univariate cox proportional hazard regression was used to assess factors associated with time to continence.
Results: Thirty patients who met the criteria underwent ACE creation at a median age of 6.5 y (interquartile range 5.3-9.8) with a median follow-up time of 11.5 mo (interquartile range 5.6-16.5). Most patients became clean by 4 mo (13 of 20, 65%) with similar results at 1-y follow-up (16 of 21, 76%). The median time to becoming clean was 4.3 mo (95% confidence interval: 1.7-15.0. Patients with hypermotility were more likely to continue to soil at 1 y (80% versus 13%, P = 0.01). There were no additional factors significantly associated with time to cleanliness.
Conclusions: ACE is a useful modality for HD patients with soiling. Most became clean of stool in 4 mo. The presence of hypermotility was associated with a higher incidence of persistent soiling at 1 y.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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