Older age at diagnosis of Hirschsprung disease decreases risk of postoperative enterocolitis, but resection of additional ganglionated bowel does not.
OBJECTIVE
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.
Division of Pediatric Surgery, University of Alabama at Birmingham, Birmingham, AL 35233, USA.
Ramanath N
RN
Haricharan
Jeong-Meen
JM
Seo
David R
DR
Kelly
Elizabeth C
EC
Mroczek-Musulman
Charles J
CJ
Aprahamian
Traci L
TL
Morgan
Keith E
KE
Georgeson
Carroll M
CM
Harmon
Jacqueline M
JM
Saito
Douglas C
DC
Barnhart
D000293:Adolescent; D017677:Age Distribution; D000714:Anastomosis, Surgical; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods; D004760:Enterocolitis / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D011336:Probability; D011351:Proctoscopy / Q000009:adverse effects / Q000379:methods; D016016:Proportional Hazards Models; D012007:Rectum / Q000294:innervation / Q000503:physiopathology; D012189:Retrospective Studies; D017678:Sex Distribution; D016896:Treatment Outcome