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Comparative Study
. 2019 May;54(5):959-963.
doi: 10.1016/j.jpedsurg.2019.01.026. Epub 2019 Jan 31.

Factors influencing the incidence of Hirschsprung associated enterocolitis (HAEC)

Annie Le-Nguyen  1 , Franziska Righini-Grunder  2 , Nelson Piché  3 , Christophe Faure  4 , Ann Aspirot  5
Affiliations
Comparative Study

Factors influencing the incidence of Hirschsprung associated enterocolitis (HAEC)

Annie Le-Nguyen et al. J Pediatr Surg. 2019 May.

Abstract

Purpose: This study aims to characterize risk factors for Hirschsprung-associated enterocolitis (HAEC). We hypothesize that earlier pull-through surgery is associated with lower risks of developing postoperative HAEC.

Methods: A comparative study of 171 Hirschsprung patients treated from 1990 to 2017 was performed. Patients without HAEC were compared to patients with preoperative and/or postoperative HAEC. Results are presented as median [IQR] or frequency (%). Pearson's χ2 test and Wilcoxon rank sum test were performed with a significance level at p < 0.05. Multivariable logistic regression analysis was used to adjust for potential confounders. A subanalysis was done to evaluate laparoscopic, laparotomy, and transanal surgeries.

Results: Risk of developing preoperative HAEC was significantly associated with congenital malformations (OR 2.63 [1.11, 6.24]; p = 0.02). Birth weight was lower in patients with preoperative HAEC (OR 0.48 [95% CI 0.25, 0.93]; p = 0.03). On regression analysis, intestinal obstruction after surgery was significantly associated with postoperative HAEC (OR 8.2 [3.18, 21.13]; p < 0.0001). Patients with earlier pull-through surgery did not have a lower risk of developing postoperative HAEC.

Conclusions: Timing of surgery does not seem to be associated with a higher risk of developing pre- and postoperative HAEC. Predisposing factors for preoperative HAEC included associated malformations and lower birth weight, whereas intestinal obstruction was found to be associated with postoperative HAEC.

Type of study: Treatment study.

Level of evidence: Level III.

Keywords: Complications; HSCR; Hirschsprung disease; Hirschsprung-associated enterocolitis; Pull-through surgery; Risk factors.

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