Prevention and management of recurrent postoperative Hirschsprung's disease obstructive symptoms and enterocolitis: Systematic review and meta-analysis

Journal of Pediatric Surgery
Han Jie SohMaurizio Pacilli

Abstract

The purpose of this study was to review the management of obstructive symptoms and enterocolitis (HAEC) following pull-through for Hirschsprung's disease. A systematic review and meta-analysis (1992-2017) was performed. Included studies were: randomized controlled trials (RCT), retrospective/prospective case-control (C-C), case-series (C-S). Random-effect model was used to produce risk ratio (RR) [95% CI]. P < 0.05 was considered significant. Twenty-nine studies were identified. Routine postoperative dilatations (5 C-S, 2 C-C; 405 patients): no effect on stricture incidence (RR 0.3 [0.02-5.7]; p = 0.4). Routine postoperative rectal irrigations (2 C-C; 172 patients): reduced HAEC incidence (RR 0.2 [0.1-0.5]; p = 0.001). Posterior myotomy/myectomy (4 C-S; 53 patients): resolved obstructive symptoms in 79% [60.6-93.5] and HAEC in 80% [64.1-92.1]. Botulinum toxin injection (9 C-S; 166 patients): short-term response in 77.3% [68.2-85.2], long-term response in 43.0% [26.9-59.9]. Topical nitric oxide (3 C-S; 13 patients): improvement in 100% of patients. Probiotic prophylaxis (3 RCT; 160 patients): no reduction in HAEC (RR 0.6 [0.2-1.7]; p = 0.3). Anti-inflammatory drugs (1 C-S, sodium cromoglycate; 8 patients): improvement of HAEC in...Continue Reading

Citations

Oct 2, 2020·Pediatric Surgery International·Wendy Jo SvetanoffRebecca M Rentea
Nov 22, 2019·Pediatric and Developmental Pathology : the Official Journal of the Society for Pediatric Pathology and the Paediatric Pathology Society·Caitlin SmithRaj P Kapur
Jul 25, 2019·World Journal of Gastroenterology : WJG·Daniëlle RoordaJoep Pm Derikx
Sep 19, 2020·European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery ... [et Al] = Zeitschrift Für Kinderchirurgie·Mark A TaylorMichael D Rollins
Jan 14, 2021·European Journal of Pediatric Surgery Reports·Anisha ApteMarc A Levitt
Jun 4, 2021·Journal of Pediatric Surgery·Daniëlle RoordaJoep P M Derikx
Oct 12, 2021·Current Gastroenterology Reports·Hira AhmadJacob C Langer

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