Unexpected gap between intraoperative caliber change of the intestine and normoganglia in patients with intestinal aganglionosis

• Published in: Pediatric surgery international Vol. 35; no. 10; pp. 1115 - 1121
• Main Authors: Sekioka, Akinori, Fukumoto, Koji, Miyake, Hiromu, Nakaya, Kengo, Nomura, Akiyoshi, Yamada, Yutaka, Yamada, Susumu, Urushihara, Naoto
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-10-2019; Springer Nature B.V
• Subjects: Age; Birth weight; Digestive System Surgical Procedures - methods; Hirschsprung Disease - diagnosis; Hirschsprung Disease - surgery; Humans; Infant; Infant, Newborn; Intraoperative Period; Male; Medical prognosis; Medicine; Medicine & Public Health; Original Article; Ostomy; Pediatric Surgery; Pediatrics; Rectum - diagnostic imaging; Rectum - surgery; Retrospective Studies; Surgery; Treatment Outcome; Total colonic aganglionosis; Intestinal aganglionosis; Extent of aganglionosis; Caliber change; Initial stoma
• ISSN: 0179-0358; 1437-9813
• DOI: 10.1007/s00383-019-04534-w

Purpose
Intestinal aganglionosis (IA) is so rare that the entity remains unclear. The aim of the present study was to compare the outcomes of patients with IA and those with total colonic aganglionosis (TCA).
Methods
The hospital records were retrospectively reviewed from 1977 to 2018. Outcomes were analyzed for the IA group and the TCA group, including clinical presentation, initial management, and operative details.
Results
There were
s
ix patients were managed in IA (all male) and seven patients in TCA (4 male). The median age at the first operation was significantly younger in IA than TCA (2 days vs 24 days,
p
 = 0.01). The gap between the intraoperative caliber change (CC) of the intestine and the initial stoma location was not significantly different (7.5 cm vs 12 cm,
p
 = 0.61), but the rate of stoma dysfunction was significantly higher in IA (83% vs 0%,
p
 = 0.005). The gap between the CC and the ganglionated bowel was significantly longer in IA (85 cm vs 10 cm,
p
 = 0.003).
Conclusion
Patients with IA appear to have a high risk for stoma dysfunction after the first operation because of the unexpected gap between the CC and normoganglia. The initial location of the stoma requires careful consideration.