Evaluation and Management of Total Colonic Hirschsprung Disease: A Comprehensive Review From the American Pediatric Surgical Association (APSA) Hirschsprung Disease Interest Group.

Document Type

Article

Publication Date

11-2024

Identifier

DOI: 10.1016/j.jpedsurg.2024.08.017

Abstract

BACKGROUND: Children with total colonic Hirschsprung disease (TCHD) are a unique group of patients with pre- and postoperative management challenges. This review provides a rational, expert-based approach to diagnosing and managing TCHD.

METHODS: The guidelines were developed by the Hirschsprung Disease Interest Group members established by the American Pediatric Surgical Association (APSA) Board of Governors. Group discussions, literature review, and expert consensus were used to summarize the current knowledge regarding diagnosis, staged approach, the timing of pull-through, and pre-and postoperative management in children with TCHD.

RESULTS: This paper presents recommendations for managing TCHD before and after reconstruction, including diagnostic criteria, surgical approaches, bowel management, diet, antibiotic prophylaxis, colonic irrigations, and post-surgical considerations.

CONCLUSIONS: A clear understanding of the unique challenges posed by TCHD and consensus on its treatment are lacking in the literature. This review standardizes this patient group's pre- and postoperative management.

LEVEL OF EVIDENCE: V.

Journal Title

Journal of pediatric surgery

Volume

59

Issue

11

First Page

161677

Last Page

161677

MeSH Keywords

Humans; Hirschsprung Disease; Child; Postoperative Care; Postoperative Complications; Antibiotic Prophylaxis; Colectomy

Keywords

Hirschsprung disease; Pull-through; Short bowel syndrome; Small intestinal Hirschsprung disease; Total colonic Hirschsprung disease; Total intestinal aganglionosis

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