Postoperative outcomes and predictors of Hirschsprung-associated enterocolitis after transanal endorectal pull-through: a single-centre retrospective cohort of 71 patients

Abstract

Objective: To describe the perioperative and longer-term outcomes of a single-center cohort undergoing transanal endorectal pull-through (TEPT) for Hirschsprung disease (HSCR), and to identify independent predictors of postoperative Hirschsprung-associated enterocolitis (HAEC). Method: A retrospective review of 71 patients undergoing TEPT at a single institution was performed. Postoperative HAEC was analysed under two definitions: early postoperative HAEC (within the first postoperative year) and any postoperative HAEC during follow-up. Anastomotic stricture was reported under a broad clinical definition and a strict definition restricted to cases requiring operative revision. Univariate and multivariable logistic regression with four a priori covariates (age at surgery, preoperative HAEC, long/total-segment aganglionosis, one-stage operation) was used to identify independent predictors of postoperative HAEC. Results: Median age at definitive surgery was 2.0 months and median follow-up was 60 months. Anastomotic stricture occurred in 35.2% under the broad definition and 9.9% under the strict definition. Early postoperative HAEC was documented in 12.7% and any postoperative HAEC in 22.5%. Preoperative HAEC was an independent predictor of both early and any postoperative HAEC. One-stage pull-through was independently protective against any postoperative HAEC. Long- or total-segment aganglionosis was associated with a higher broad-definition stricture rate (62.5% vs 27.3%, p=0.016) but not the strict definition (12.5% vs 9.1%, p=0.651). Conclusion: Preoperative HAEC and one-stage operation are independently associated with postoperative HAEC after TEPT. Reporting anastomotic stricture under both broad and strict definitions improves comparability with other single-center series.