TY - JOUR
T1 - Risk factors for short-term complications graded by Clavien-Dindo after transanal endorectal pull-through in patients with Hirschsprung disease
AU - Beltman, Lieke
AU - Roorda, Daniëlle
AU - Backes, Manouk
AU - Oosterlaan, Jaap
AU - van Heurn, L W Ernest
AU - Derikx, Joep P M
N1 - Funding Information: Conflicts of Interest and Sources of Funding: None of the authors have any conflicts-of-interest to disclose. This study was supported with a grant from the Dutch patient association for Hirschsprung disease. Publisher Copyright: © 2021 The Authors Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2021/8/1
Y1 - 2021/8/1
N2 - Background: Transanal endorectal pull-through (TERPT) is a common surgical procedure in Hirschsprung disease (HD). Aim of this study was to gain insight in the prevalence and severity of postoperative complications within 30-days after TERPT and to identify patient and perioperative characteristics, associated with the development of short-term postoperative complications. Methods: This study retrospectively analyzed data of children with HD and treated with TERPT in our center between 2005 and 2020. Complications emerging within 30-days after surgery were assessed using Clavien-Dindo (CD). Patient and perioperative characteristic as predictor of a complication were tested using (multivariable) logistic regression analysis. Results: Twenty-two of 106 (21%) included patients (17 transanal only; 77 laparoscopic-assisted; 12 laparotomy-assisted) developed 35 complications, including two patients (1.8%) that deceased. We suspect postoperative rectal irrigation leading to perforation as cause of death in both patients. Six patients (6%) had a minor (CD<3) and 16 patients (15%) a major (CD≥3) complication. Anastomotic leakage (n = 4, 11%), abdominal abscess (n = 3, 9%) and anastomotic stricture (n = 3,9%) occurred most frequently. Predictive factors for developing a complication were older age at time of surgery (OR 1.03 1.00–1.01, p = 0.041), laparotomy-assisted surgery (OR 12.65, CI 1.712–93.07, p = 0.013) and long-segment HD (OR 4.09 CI 1.09–15.39, p = 0.037). Conclusions: We found a CD-graded short-term postoperative complication rate of 21% following TERPT, reporting anastomotic complications most frequently. In patients at risk a diverting stoma should be considered. We suspect postoperative rectal irrigation being the cause of two lethal perforations. Therefore, we recommend to place a rectal transanastomotic tube in all patients receiving TERPT. Level of Evidence: Level III.
AB - Background: Transanal endorectal pull-through (TERPT) is a common surgical procedure in Hirschsprung disease (HD). Aim of this study was to gain insight in the prevalence and severity of postoperative complications within 30-days after TERPT and to identify patient and perioperative characteristics, associated with the development of short-term postoperative complications. Methods: This study retrospectively analyzed data of children with HD and treated with TERPT in our center between 2005 and 2020. Complications emerging within 30-days after surgery were assessed using Clavien-Dindo (CD). Patient and perioperative characteristic as predictor of a complication were tested using (multivariable) logistic regression analysis. Results: Twenty-two of 106 (21%) included patients (17 transanal only; 77 laparoscopic-assisted; 12 laparotomy-assisted) developed 35 complications, including two patients (1.8%) that deceased. We suspect postoperative rectal irrigation leading to perforation as cause of death in both patients. Six patients (6%) had a minor (CD<3) and 16 patients (15%) a major (CD≥3) complication. Anastomotic leakage (n = 4, 11%), abdominal abscess (n = 3, 9%) and anastomotic stricture (n = 3,9%) occurred most frequently. Predictive factors for developing a complication were older age at time of surgery (OR 1.03 1.00–1.01, p = 0.041), laparotomy-assisted surgery (OR 12.65, CI 1.712–93.07, p = 0.013) and long-segment HD (OR 4.09 CI 1.09–15.39, p = 0.037). Conclusions: We found a CD-graded short-term postoperative complication rate of 21% following TERPT, reporting anastomotic complications most frequently. In patients at risk a diverting stoma should be considered. We suspect postoperative rectal irrigation being the cause of two lethal perforations. Therefore, we recommend to place a rectal transanastomotic tube in all patients receiving TERPT. Level of Evidence: Level III.
KW - Abbreviations
KW - CD
KW - Clavien-Dindo
KW - Complications
KW - Hirschsprung disease
KW - TERPT
KW - Transanal endorectal pull-through
KW - clavien-dindo
KW - transanal endorectal pull-through
UR - http://www.scopus.com/inward/record.url?scp=85113600603&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jpedsurg.2021.07.024
DO - https://doi.org/10.1016/j.jpedsurg.2021.07.024
M3 - Article
C2 - 34452757
SN - 0022-3468
JO - Journal of Pediatric Surgery
JF - Journal of Pediatric Surgery
ER -