{"title":"Decisions in Diversion: Enterostomy vs. Primary Anastomosis for Colonic Atresia.","authors":"Utsav Patwardhan, Dylan Griffiths, Gerald Gollin","doi":"10.1016/j.jpedsurg.2024.161903","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Colonic atresia (CA) is associated with Hirschsprung disease (HD) in up to 10% of cases. Therefore, some surgeons elect to complete proximal diversion at the initial operation. We sought to better define the incidence of concurrent HD and evaluate practice patterns regarding diversion for CA.</p><p><strong>Methods: </strong>The Pediatric Health Information System (PHIS) database was used to identify patients with CA from 2013 to 2022. Patients with small bowel atresia, anorectal malformation, gastroschisis, or first operation after 14 days of age were excluded. Index and subsequent operations were defined. Complications, time to enterostomy closure, and unplanned operations were evaluated.</p><p><strong>Results: </strong>HD was diagnosed in 8 (9.5%) patients and 7 of these were initially diverted. Diverted and anastomosed patients were demographically similar. In the 58 (69%) patients initially diverted, 19 (33%) had an ileostomy. Continuity was restored with an ileo-colic anastomosis in 63% of diverted and 27% of primarily anastomosed patients. Of those initially managed with a colostomy, 53% ultimately had a colo-colonic anastomosis. Patients with primary anastomoses had fewer operations and received more days of parenteral nutrition. Other outcomes did not vary.</p><p><strong>Conclusion: </strong>In a large population of infants with CA, 9.5% had concurrent HD. Almost 70% of CA patients underwent initial diversion and only one with HD had a primary anastomosis. Patients managed with a primary anastomosis were substantially more likely to retain the proximal colonic segment, but had a similar incidence of complications. When intraoperative colonic biopsies are obtained, primary anastomosis is a safe and effective strategy for CA.</p><p><strong>Level of evidence: 3: </strong></p>","PeriodicalId":16733,"journal":{"name":"Journal of pediatric surgery","volume":null,"pages":null},"PeriodicalIF":2.4000,"publicationDate":"2024-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of pediatric surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jpedsurg.2024.161903","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Colonic atresia (CA) is associated with Hirschsprung disease (HD) in up to 10% of cases. Therefore, some surgeons elect to complete proximal diversion at the initial operation. We sought to better define the incidence of concurrent HD and evaluate practice patterns regarding diversion for CA.
Methods: The Pediatric Health Information System (PHIS) database was used to identify patients with CA from 2013 to 2022. Patients with small bowel atresia, anorectal malformation, gastroschisis, or first operation after 14 days of age were excluded. Index and subsequent operations were defined. Complications, time to enterostomy closure, and unplanned operations were evaluated.
Results: HD was diagnosed in 8 (9.5%) patients and 7 of these were initially diverted. Diverted and anastomosed patients were demographically similar. In the 58 (69%) patients initially diverted, 19 (33%) had an ileostomy. Continuity was restored with an ileo-colic anastomosis in 63% of diverted and 27% of primarily anastomosed patients. Of those initially managed with a colostomy, 53% ultimately had a colo-colonic anastomosis. Patients with primary anastomoses had fewer operations and received more days of parenteral nutrition. Other outcomes did not vary.
Conclusion: In a large population of infants with CA, 9.5% had concurrent HD. Almost 70% of CA patients underwent initial diversion and only one with HD had a primary anastomosis. Patients managed with a primary anastomosis were substantially more likely to retain the proximal colonic segment, but had a similar incidence of complications. When intraoperative colonic biopsies are obtained, primary anastomosis is a safe and effective strategy for CA.
背景：结肠闭锁（CA）与赫氏prung 病（HD）相关的病例高达 10%。因此，一些外科医生选择在初次手术时完成近端转流。我们试图更好地界定并发 HD 的发生率，并评估 CA 引流的实践模式：我们使用儿科健康信息系统（PHIS）数据库来识别2013年至2022年的CA患者。排除了小肠闭锁、肛门直肠畸形、胃裂或14天后首次手术的患者。定义了首次手术和后续手术。对并发症、肠造口关闭时间和计划外手术进行了评估：结果：8 例（9.5%）患者被诊断为 HD，其中 7 例最初进行了肠道转流。转流患者和吻合患者的人口统计学特征相似。在 58 名（69%）最初进行转流的患者中，19 名（33%）进行了回肠造口术。63%的转流患者和 27% 的主要吻合患者通过回肠结肠吻合术恢复了连续性。在最初接受结肠造口术的患者中，53%最终进行了结肠-结肠吻合术。主要吻合的患者手术次数较少，接受肠外营养的天数较多。其他结果没有差异：结论：在大量 CA 婴儿中，9.5% 同时患有 HD。近 70% 的 CA 患者接受了初次转流，只有一名 HD 患者进行了初次吻合。接受初次吻合术的患者保留近端结肠段的几率要高得多，但并发症的发生率相似。如果在术中进行结肠活检，初次吻合术是一种安全有效的 CA 治疗策略：3:
期刊介绍：
The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.
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