Postoperative Hirschsprung's enterocolitis after minimally invasive Swenson's procedure.
OBJECTIVE
Our preferred minimally invasive technique of Swenson's procedure has evolved from laparoscopic (LapSwen) to Swenson's transanal pullthrough (SWAP). We studied the incidence of postoperative Hirschsprung's enterocolitis (HEC) over the past decade.


METHODS
We retrospectively reviewed the charts of 52 children who had a primary Swenson's pullthrough procedure between 1995 and 2006. Two cohorts (25 LapSwen [1995-2000] and 27 SWAP [1998-2006]) were compared.


RESULTS
Median ages of diagnosis were 13 days for LapSwen and 4 days for SWAP. Median age at surgery was 4.1 months for LapSwen and 3.3 months for SWAP. Postoperative HEC occurred in 12% (16% LapSwen, 7.4% SWAP). The incidence of Down's syndrome and preoperative HEC did not differ between the 2 cohorts. Three children with HEC were Clostridium difficile-positive. Long-term function in the 36 children older than 4 years was excellent in 22%, good in 50%, fair in 11% and poor in 17%.


CONCLUSIONS
Our incidence of postoperative HEC is low, and we have seen a trend toward fewer cases after the SWAP procedure. Early diagnosis, preoperative rectal irrigations, and routine postoperative anal dilatation may be contributing to the elimination of HEC as a significant risk after surgery for Hirschsprung's disease.
Singh
Ravinder
R
McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada L8N 3Z5.
Cameron
Brian H
BH
Walton
Johnathan M
JM
Farrokhyar
Forough
F
Borenstein
Steven H
SH
Fitzgerald
Peter G
PG
D002648:Child; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004760:Enterocolitis / Q000453:epidemiology*; D005260:Female; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric