Temporal Dynamics of Postoperative Enterocolitis in Hirschsprung Disease: A Comparative Analysis of Earlier Onset After TAERPT versus the Duhamel Procedure
DOI:
https://doi.org/10.37275/bsm.v10i1.1478Keywords:
Duhamel procedure, Hirschsprung-associated enterocolitis (HAEC), Hirschsprung disease, Postoperative, Transanal endorectal pull-through (TAERPT)Abstract
Background: Hirschsprung-associated enterocolitis (HAEC) remains the most formidable cause of morbidity in surgically corrected Hirschsprung disease (HD). While the transanal endorectal pull-through (TAERPT) and the Duhamel procedure are standard treatments, a critical knowledge gap exists regarding the timing of postoperative HAEC onset associated with each technique. This study aimed to investigate and compare the temporal dynamics of HAEC presentation following these distinct surgical reconstructions.
Methods: This single-center, retrospective cohort study reviewed 64 HD patients who underwent either TAERPT (n=32) or a modified Duhamel procedure (n=32) between January 2022 and January 2023 at a tertiary referral hospital. The primary outcome was the incidence of severe HAEC (HAEC score ≥10). The principal secondary outcome was the time to onset of the first episode of mild-to-moderate HAEC (score <10). Due to the non-normal distribution of onset data, the Mann-Whitney U test was used for statistical comparison.
Results: Baseline demographic and clinical characteristics were comparable between the two cohorts. The incidence of severe HAEC was 0% in both the TAERPT and Duhamel groups. All recorded complications were mild-to-moderate and managed non-surgically. A statistically significant and clinically profound difference in the timing of these complications was observed. The median onset of HAEC in the TAERPT group was 6.0 months (Interquartile Range [IQR], 3.0-6.0), which was significantly earlier than the median onset of 8.5 months (IQR, 3.0-24.0) in the Duhamel group (p < 0.001). The mean onset times were 5.50 ± 1.90 months and 16.09 ± 16.33 months, respectively.
Conclusion: Although both TAERPT and the Duhamel procedure demonstrated excellent safety profiles regarding severe HAEC, their associated temporal patterns of mild-to-moderate enterocolitis are markedly different. The significantly earlier onset of complications following TAERPT suggests that postoperative surveillance strategies should be procedure-specific, with intensified clinical vigilance during the first postoperative year for TAERPT patients.
Authors
- Anisa Ika Pratiwi1*
- Nunik Agustriani2
- Suwardi2
- Ida Bagus Budhi Surya Adnyana3
- Henky Agung Nugroho4
- 1Department of General Surgery, Faculty of Medicine, Universitas Sebelas Maret/Dr. Moewardi Regional General Hospital, Surakarta, Indonesia
- 2Department of Pediatric Surgery, Faculty of Medicine, Universitas Sebelas Maret/Dr. Moewardi Regional General Hospital, Surakarta, Indonesia
- 3Department of Digestive Surgery, Faculty of Medicine, Universitas Sebelas Maret/Dr. Moewardi Regional General Hospital, Surakarta, Indonesia
- 4Department of Oncology Surgery, Faculty of Medicine, Universitas Sebelas Maret/Dr. Moewardi Regional General Hospital, Surakarta, Indonesia
Corresponding author Anisa Ika Pratiwi — anisaikapratiwi13@gmail.com
Article history
- Submitted
- Accepted
- Published
Downloads
Published
Issue
Section
License
Copyright and licensing
Copyright in each article remains with the author(s). Authors grant Bioscientia Medicina: Journal of Biomedicine and Translational Research a non-exclusive right of first publication and the right to identify itself as the original publisher. No exclusive transfer of copyright is required.
All articles are published under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License (CC BY-NC-SA 4.0): https://creativecommons.org/licenses/by-nc-sa/4.0/. Users may copy, redistribute, remix, transform, and build upon the material for non-commercial purposes, provided appropriate attribution is given, a link to the license is supplied, changes are indicated, and adaptations are distributed under the same license.
The license applies to the article's scholarly content unless a credit line states otherwise. Third-party material may be subject to separate rights. Authors retain patent, trademark, moral, and research-data rights. The copyright year follows the article's publication date.
