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.

中文翻译：

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Clavien-Dindo 对先天性巨结肠患者经肛门直肠内穿刺术后短期并发症的危险因素

背景

经肛门直肠内引流术 (TERPT) 是先天性巨结肠 (HD) 常见的外科手术。本研究的目的是深入了解 TERPT 后 30 天内术后并发症的发生率和严重程度，并确定与短期术后并发症发生相关的患者和围手术期特征。

方法

本研究回顾性分析了 2005 年至 2020 年间在我们中心接受 TERPT 治疗的 HD 儿童数据。使用 Clavien-Dindo (CD) 评估术后 30 天内出现的并发症。使用（多变量）逻辑回归分析测试了作为并发症预测因子的患者和围手术期特征。

结果

106 名患者中有 22 名（21%）（仅经肛门 17 名；腹腔镜辅助 77 名；剖腹手术辅助 12 名）出现 35 种并发症，其中 2 名患者（1.8%）死亡。我们怀疑术后直肠冲洗导致穿孔是两名患者的死亡原因。6 名患者 (6%) 有轻微 (CD<3) 并发症，16 名患者 (15%) 有严重 (CD≥3) 并发症。吻合口漏（n  = 4, 11%）、腹腔脓肿（n  = 3, 9%）和吻合口狭窄（n  = 3,9%）最常见。发生并发症的预测因素是手术时年龄较大（OR 1.03 1.00-1.01，p  = 0.041），剖腹手术辅助手术（OR 12.65，CI 1.712-93.07，p = 0.013) 和长段 HD (OR 4.09 CI 1.09–15.39, p  = 0.037)。

结论

我们发现 TERPT 后 CD 分级的短期术后并发症发生率为 21%，最常报告吻合口并发症。对于有风险的患者，应考虑分流造口。我们怀疑术后直肠冲洗是两个致命穿孔的原因。因此，我们建议在所有接受 TERPT 的患者中放置直肠经吻合管。

证据水平

三级。