Risk factors for short-term complications graded by Clavien-Dindo after transanal endorectal pull-through in patients with Hirschsprung disease

• Published in: Journal of pediatric surgery Vol. 57; no. 8; pp. 1460 - 1466
• Main Authors: Beltman, Lieke, Roorda, Daniëlle, Backes, Manouk, Oosterlaan, Jaap, van Heurn, L.W. Ernest, Derikx, Joep P.M.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-08-2022
• Subjects: Abbreviations; Clavien-Dindo; Complications; Hirschsprung disease; TERPT; Transanal endorectal pull-through; CD; Complications; TERPT; Hirschsprung disease; Clavien-Dindo; Transanal endorectal pull-through; Abbreviations
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2021.07.024

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.
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.
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).
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.
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