Optimal timing for Soave primary pull-through in short-segment Hirschsprung disease: A meta-analysis.
Endorectal pull-through
Hirschsprung disease
Short-segment Hirschsprung disease
Soave pull-through
Journal
Journal of pediatric surgery
ISSN: 1531-5037
Titre abrégé: J Pediatr Surg
Pays: United States
ID NLM: 0052631
Informations de publication
Date de publication:
Apr 2022
Apr 2022
Historique:
received:
10
03
2021
revised:
15
06
2021
accepted:
07
07
2021
pubmed:
1
8
2021
medline:
16
3
2022
entrez:
31
7
2021
Statut:
ppublish
Résumé
The optimal age for endorectal pull-through (ERPT) surgery in infants with short-segment Hirschsprung disease varies, with a trend toward earlier surgery. However, it is unclear if the timing of surgery impacts functional outcomes. We undertook the present study to determine the optimal timing of ERPT in infants with short-segment Hirschsprung disease. The NCBI PubMed database was searched for English-language manuscripts published between 2000 and 2019 analyzing functional outcomes for patient following the initial Soave ERPT for short-segment Hirschsprung disease. Raw data from these studies was obtained from the corresponding author for each manuscript. We combined data from these papers with our own institutional data and performed a meta-analysis. A total of 780 infants were included in our meta-analysis. Constipation occurred in 1.0-31.7%, soiling 1.3-26.0%, anastomotic stricture 0.0-14.6%, and anastomotic leak 0.0-3.4%. Regarding age at ERPT, younger infants at the time of initial corrective surgery had higher rates of soiling, stricture, and leak. On sub-group analysis, patients <2.5 months at their initial corrective surgery had higher rates of soiling (25.9% vs. 11.4%, p<0.01), as well as stricture (10.0% vs 1.7%, p<0.01) and leak (5.5% vs 1.3%, p<0.01). While age at Soave endorectal pull-through for short-segment Hirschsprung disease has decreased over time, functional outcomes associated with this trend have only recently been examined. Our findings suggest that patients <2.5 months old at the time of endorectal pull-through may have worse functional outcomes, emphasizing the need to consider further study of the timing of surgery in this population.
Sections du résumé
BACKGROUND
BACKGROUND
The optimal age for endorectal pull-through (ERPT) surgery in infants with short-segment Hirschsprung disease varies, with a trend toward earlier surgery. However, it is unclear if the timing of surgery impacts functional outcomes. We undertook the present study to determine the optimal timing of ERPT in infants with short-segment Hirschsprung disease.
METHODS
METHODS
The NCBI PubMed database was searched for English-language manuscripts published between 2000 and 2019 analyzing functional outcomes for patient following the initial Soave ERPT for short-segment Hirschsprung disease. Raw data from these studies was obtained from the corresponding author for each manuscript. We combined data from these papers with our own institutional data and performed a meta-analysis.
RESULTS
RESULTS
A total of 780 infants were included in our meta-analysis. Constipation occurred in 1.0-31.7%, soiling 1.3-26.0%, anastomotic stricture 0.0-14.6%, and anastomotic leak 0.0-3.4%. Regarding age at ERPT, younger infants at the time of initial corrective surgery had higher rates of soiling, stricture, and leak. On sub-group analysis, patients <2.5 months at their initial corrective surgery had higher rates of soiling (25.9% vs. 11.4%, p<0.01), as well as stricture (10.0% vs 1.7%, p<0.01) and leak (5.5% vs 1.3%, p<0.01).
CONCLUSION
CONCLUSIONS
While age at Soave endorectal pull-through for short-segment Hirschsprung disease has decreased over time, functional outcomes associated with this trend have only recently been examined. Our findings suggest that patients <2.5 months old at the time of endorectal pull-through may have worse functional outcomes, emphasizing the need to consider further study of the timing of surgery in this population.
Identifiants
pubmed: 34330420
pii: S0022-3468(21)00496-6
doi: 10.1016/j.jpedsurg.2021.07.007
pmc: PMC8776908
mid: NIHMS1728562
pii:
doi:
Types de publication
Journal Article
Meta-Analysis
Langues
eng
Sous-ensembles de citation
IM
Pagination
719-725Subventions
Organisme : NIDDK NIH HHS
ID : F32 DK121440
Pays : United States
Organisme : NIDDK NIH HHS
ID : R01 DK103785
Pays : United States
Organisme : NIDDK NIH HHS
ID : T32 DK007754
Pays : United States
Informations de copyright
Copyright © 2021 Elsevier Inc. All rights reserved.
Références
Pediatr Surg Int. 2018 Feb;34(2):183-188
pubmed: 28983691
Ann Surg. 2013 Feb;257(2):371-5
pubmed: 23263193
J Pediatr Surg. 2015 Nov;50(11):1865-9
pubmed: 26164226
J Pediatr Surg. 2017 Jul;52(7):1102-1107
pubmed: 28185631
J Pediatr Surg. 1995 Mar;30(3):491-4
pubmed: 7760250
Pediatr Surg Int. 2018 Jan;34(1):47-53
pubmed: 29075908
Int J Colorectal Dis. 2019 Feb;34(2):255-259
pubmed: 30368570
Ann Surg. 1975 Sep;182(3):266-73
pubmed: 1164055
Updates Surg. 2012 Jun;64(2):113-8
pubmed: 22392576
Semin Pediatr Surg. 2012 Nov;21(4):336-43
pubmed: 22985839
Ann R Coll Surg Engl. 2011 Jan;93(1):34-8
pubmed: 20738896
J Pediatr Surg. 1999 Jul;34(7):1152-60
pubmed: 10442612
N Engl J Med. 1949 Oct 13;241(15):551-6
pubmed: 18142742
J Pediatr Surg. 1997 Mar;32(3):505-9
pubmed: 9094029
J Pediatr Surg. 1980 Aug;15(4):470-1
pubmed: 7411359
Zhonghua Wei Chang Wai Ke Za Zhi. 2015 May;18(5):459-62
pubmed: 26013864
J Pediatr Surg. 1982 Jun;17(3):241-3
pubmed: 6809925
Ann Surg. 2010 Dec;252(6):977-81
pubmed: 21107107
Zhonghua Wei Chang Wai Ke Za Zhi. 2016 Oct 25;19(10):1160-1164
pubmed: 27781255
J Pediatr Surg. 1979 Oct;14(5):588-97
pubmed: 512801
J Gastrointest Surg. 2018 Feb;22(2):335-343
pubmed: 28956279
J Pediatr Surg. 1989 Oct;24(10):1032-4
pubmed: 2681654
Clin Perinatol. 2017 Dec;44(4):851-864
pubmed: 29127965
Eur J Pediatr Surg. 2018 Dec;28(6):522-528
pubmed: 29059696
J Pediatr Surg. 2017 Sep;52(9):1458-1464
pubmed: 28094015
Ann Surg. 2000 Sep;232(3):372-80
pubmed: 10973387
Ann Surg. 2017 Mar;265(3):622-629
pubmed: 28169931
J Perinatol. 2019 Aug;39(8):1105-1110
pubmed: 31209278
J Pediatr Surg. 2014 Nov;49(11):1619-25
pubmed: 25475806