Comparison of Hirschsprung-associated enterocolitis following Soave and Duhamel procedures

Abstract

Background: Hirschsprung-associated enterocolitis (HAEC) represents the primary cause of high morbidity and mortality in Hirschsprung disease (HSCR) patients. The most common surgical methods for HSCR are the Soave and Duhamel procedures. Therefore, we aimed to compare the HAEC frequency following the Soave and Duhamel procedures.

Methods: Medical records were retrospectively analyzed for patients who underwent the Soave and Duhamel pull-through at Dr. Sardjito Hospital, Indonesia from 2010 to 2015. The diagnosis of HAEC was determined using a HAEC scoring system.

Results: One hundred patients were involved (Soave: 52 males and 19 females vs. Duhamel: 23 males and 6 females, p=0.62). There was significant difference in mean age at pull-through (Soave: 29.9±45.2 vs. Duhamel: 50.8±47.5months, p=0.04), whereas mean age of HSCR diagnosis and pre-operative enterocolitis frequency did not differ significantly between groups (Soave: 25.4±41.0 vs. Duhamel: 43.7±48.1months, p=0.06, and Soave: 7% vs. Duhamel: 14%, p=0.44, respectively). The HAEC frequency after pull-through was significantly higher in the Duhamel than the Soave group (28% vs. 10%, respectively, p=0.03). Furthermore, pre-operative enterocolitis showed a significant association with HAEC following pull-through (p=2.0×10-4) and the risk of HAEC after Soave pull-through was increased in long-segment aganglionosis compared to short-segment HSCR (p=0.015).

Conclusions: The frequency of HAEC was significantly higher after the Duhamel than the Soave procedure. Moreover, patients with pre-operative enterocolitis are prone to have HAEC following pull-through.

Level of evidence: III.

Keywords: Duhamel; HAEC following pull-through; Hirschsprung; Pre-operative enterocolitis; Soave.