The use of stomas in the early management of Hirschsprung’s Disease: Findings of a National, Prospective Cohort Study

Journal article

Background

Primary pull-through without a stoma has become preferred practice in managing Hirschsprung’s disease (HD). The aims of this study were to establish stoma rate and identify factors associated with stoma formation in a population-based cohort in the UK and Ireland.

Methods

Live-born infants with HD were prospectively identified in all 28 specialist paediatric surgical units in the UK and Ireland between October 2010 to September 2012. Method of colonic decompression was recorded and multivariable logistic regression was used to identify factors associated with stoma formation.

Results

305 infants with HD were identified. Rectal washouts were initially used in 86% (263) with a defunctioning stoma formed as the primary management in 13% (39). Ultimately, 36% (111) required a stoma prior to definitive surgery. Compared to infants managed with rectal washouts alone; infants managed with a stoma were more likely to have a right-sided transition zone, Down (or another) syndrome, and HD diagnosis established more than 28 days after presentation.

Conclusions

Although rectal washouts are commonly employed, a stoma prior to definitive surgery was required in 36% of infants in a national cohort. Delayed diagnosis, right-sided disease and presence of other anomalies are associated with stoma formation.

Authors: Bradnock, T; Knight, M; Kenny, S; Nair, M; Walker, G

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Elsevier
• Journal: Journal of Pediatric Surgery
• Volume: 52
• Issue: 9
• Pages: 1451-1457
• Publication date: 2017-05-01
• Acceptance date: 2017-05-10
• DOI: 10.1016/j.jpedsurg.2017.05.008
• EISSN: 1531-5037
• ISSN: 0022-3468
• Keywords: incidence; stoma; presentation; Hirschsprung's disease; management