An approach to minimize postoperative enterocolitis in Hirschsprung's disease.
OBJECTIVE
Enterocolitis (EC) is a common and severe complication after pull-through for Hirschsprung's disease; its pathogenesis remains unclear, but the role of coexistent intestinal neuronal dysplasia (IND) in the proximal colon may be relevant. This study evaluated the relationship between postoperative EC and IND and assessed whether a surgical protocol including resection of coexistent IND could prevent postoperative EC.


METHODS
Between June 1993 and June 2002, 36 patients with aganglionosis were submitted to definitive surgical treatment. There were 2 sequential sets of patients: group I (n = 17), in whom the resection was confined to the aganglionic colon, and group II (n = 19), who were additionally submitted to resection of the coexistent IND segment; excision was restricted to the hepatic flexure in long segmental IND. The prevalence of postoperative EC and anorectal function were evaluated and compared between the 2 groups.


RESULTS
There was no mortality. Fifteen patients had isolated aganglionosis, and 21 presented with aganglionosis plus proximal IND. All 6 children who developed postoperative EC had coexistent IND. In group I, 9 patients had coexistent IND and 5 developed postoperative EC (5/17, 29%). In group II, 12 patients had coexistent IND but only 1 patient, with long segmental IND, developed postoperative EC (1/19, 5%). Among the patients with proximal IND, the prevalence of postoperative EC was 29%; but it was significantly lower in group II than in group I (1/12 or 8% vs 5/9 or 56%; P = .02). Anorectal function was excellent or good in more than 80% of the patients in both groups.


CONCLUSIONS
Postoperative EC was associated with retained proximal IND, suggesting that coexisting IND may be, at least, a predictive marker for this complication. Histochemical characterization of the proximal colon with no radical resection of the IND segment seems to be an effective and safe approach to minimize the prevalence of postoperative EC.
Estevão-Costa
José
J
Division of Pediatric Surgery, Faculty of Medicine of Porto, Hospital S. João, 4200-319 Porto, Portugal. estevao.costa@hsjoao.min-saude.pt
Fragoso
Ana Catarina
AC
Campos
Miguel
M
Soares-Oliveira
Miguel
M
Carvalho
José Luis
JL
D002675:Child, Preschool; D003106:Colon / Q000294:innervation*; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D004760:Enterocolitis / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D005260:Female; D006627:Hirschsprung Disease / Q000150:complications / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009422:Nervous System Diseases / Q000150:complications / Q000601:surgery*; D015995:Prevalence