Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Clinical Research Article
  • Published:

For short-segment Hirschsprung disease, daily trans-anal irrigation before pull-through surgery is necessary?

Pediatric Research volume 98, pages 224–230 (2025)Cite this article

Abstract

Objective

To explore the role of daily trans-anal irrigation (TAI) before pull-through surgery in preventing Hirschsprung disease-associated enterocolitis (HAEC) and improving other clinical outcomes in short-segment Hirschsprung disease (HSCR).

Methods

We enrolled the children with short-segment HSCR who received primary pull-through surgery from February 2012 to August 2019 at our hospital. They were divided into two groups. Daily TAI group: daily TAI once diagnosed until undergoing surgery. Non-daily TAI group: anal dilation or glycerine enema, supplemented with TAI if these were noneffective. HAEC, nutritional status at surgery, postoperative rehabilitation, and long-term defecation function were compared.

Results

A total of 191 children were enrolled, 147 in the Daily TAI group and 44 others. 44 pairs of children were successfully matched by 1:1 propensity score matching. In all, 10 (11.36%) of the 88 children developed HAEC, 5 (5/44, 11.36%) in the Daily TAI group and 5 (5/44, 11.36%) in another, and the difference was not statistically significant (χ2 = 0.000, p = 1.000). Besides, there was no significant difference in the nutritional status at surgery, postoperative rehabilitation indicators, and the defecation function.

Conclusion

For children with short-segment HSCR, preoperative daily TAI had no significant advantage over non-daily TAI in preventing HAEC and improving other clinical outcomes.

Impact

  • For children with short-segment Hirschsprung disease, one or more times trans-anal irrigations (TAI) per day before pull-through surgery may not be necessary.

  • Daily TAI had no significant advantage over non-daily TAI in preventing preoperative and postoperative HAEC.

  • Whether to receive daily TAI before surgery did not affect postoperative recovery and long-term defecation function.

Access through your institution
Buy or subscribe

This is a preview of subscription content, access via your institution

Access options

Access through your institution

Buy this article

  • Purchase on SpringerLink
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1

Similar content being viewed by others

Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Taguchi, T., Obata, S. & Ieiri, S. Current status of Hirschsprung’s disease: based on a nationwide survey of Japan. Pediatr. Surg. Int. 33, 497–504 (2017).

    Article  PubMed  Google Scholar 

  2. Kyrklund, K. et al. Ernica guidelines for the management of rectosigmoid Hirschsprung’s disease. Orphanet J. Rare Dis. 15, 164 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  3. Westfal, M. L. et al. Optimal timing for soave primary pull-through in short-segment Hirschsprung disease: a meta-analysis. J. Pediatr. Surg. 57, 719–725 (2022).

    Article  PubMed  Google Scholar 

  4. Zani, A. et al. European paediatric surgeons’ association survey on the management of Hirschsprung disease. Eur. J. Pediatr. Surg. 27, 96–101 (2017).

    Article  PubMed  Google Scholar 

  5. Lewit, R. A., Kuruvilla, K. P., Fu, M. & Gosain, A. Current understanding of Hirschsprung-associated enterocolitis: pathogenesis, diagnosis and treatment. Semin Pediatr. Surg. 31, 151162 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  6. Zhang, Z. et al. Hirschsprung-associated enterocolitis: transformative research from bench to bedside. Eur. J. Pediatr. Surg. 32, 383–390 (2022).

    Article  CAS  PubMed  Google Scholar 

  7. Onishi, S. et al. Optimal timing of definitive surgery for Hirschsprung’s disease to achieve better long-term bowel function. Surg. Today 52, 92–97 (2022).

    Article  PubMed  Google Scholar 

  8. Lu, C. et al. Single-stage transanal endorectal pull-through procedure for correction of Hirschsprung disease in neonates and nonneonates: a multicenter study. J. Pediatr. Surg. 52, 1102–1107 (2017).

    Article  PubMed  Google Scholar 

  9. Lu, C. et al. Feasibility and efficacy of home rectal irrigation in neonates and early infancy with Hirschsprung disease. Pediatr. Surg. Int. 35, 1245–1253 (2019).

    Article  PubMed  Google Scholar 

  10. Lin, Z., Lin, Y., Bai, J., Wu, D. & Fang, Y. Outcomes of preoperative anal dilatation for Hirschsprung disease. J. Pediatr. Surg. 56, 483–486 (2021).

    Article  PubMed  Google Scholar 

  11. Zhang, J. S., Kong, C. & Li, L. Endoscopic decompression with a transanal drainage tube for the treatment of Hirschsprung’s disease in newborns. J. Laparoendosc. Adv. Surg. Tech. A 31, 959–963 (2021).

    Article  PubMed  Google Scholar 

  12. Mosiello, G. et al. Consensus review of best practice of transanal irrigation in children. J. Pediatr. Gastroenterol. Nutr. 64, 343–352 (2017).

    Article  PubMed  Google Scholar 

  13. Hill, B. & Mitchell, A. Transanal irrigation at a glance. Br. J. Nurs. 31, 308–314 (2022).

    Article  PubMed  Google Scholar 

  14. Gayer, G., Zissin, R., Apter, S., Oscadchy, A. & Hertz, M. Perforations of the rectosigmoid colon induced by cleansing enema: Ct findings in 14 patients. Abdom. Imaging 27, 453–457 (2002).

    Article  CAS  PubMed  Google Scholar 

  15. Gosain, A. et al. Guidelines for the diagnosis and management of Hirschsprung-associated enterocolitis. Pediatr. Surg. Int. 33, 517–521 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  16. Teitelbaum, D. H., Drongowski, R. A., Chamberlain, J. N. & Coran, A. G. Long-term stooling patterns in infants undergoing primary endorectal pull-through for Hirschsprung’s disease. J. Pediatr. Surg. 32, 1049–1052 (1997).

    Article  CAS  PubMed  Google Scholar 

  17. Austin, P. C. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivar. Behav. Res. 46, 399–424 (2011).

    Article  Google Scholar 

  18. Best, K. E. et al. Hirschsprung’s disease prevalence in Europe: a register based study. Birth Defects Res A Clin. Mol. Teratol. 100, 695–702 (2014).

    Article  CAS  PubMed  Google Scholar 

  19. Bradnock, T. J. & Walker, G. M. Evolution in the management of Hirschsprung’s disease in the UK and Ireland: a national survey of practice revisited. Ann. R. Coll. Surg. Engl. 93, 34–38 (2011).

    Article  CAS  PubMed  Google Scholar 

  20. Lee, C. C. et al. Clinical impacts of delayed diagnosis of Hirschsprung’s disease in newborn infants. Pediatr. Neonatol. 53, 133–137 (2012).

    Article  PubMed  Google Scholar 

  21. Beltman, L., Labib, H., Oosterlaan, J., van Heurn, E. & Derikx, J. Risk factors for complications in patients with Hirschsprung disease while awaiting surgery: beware of bowel perforation. J. Pediatr. Surg. 57, 561–568 (2022).

    Article  PubMed  Google Scholar 

  22. Kessmann, J. Hirschsprung’s disease: diagnosis and management. Am. Fam. Physician 74, 1319–1322 (2006).

    PubMed  Google Scholar 

  23. Wessner, S. & Burjonrappa, S. Review of nutritional assessment and clinical outcomes in pediatric surgical patients: does preoperative nutritional assessment impact clinical outcomes? J. Pediatr. Surg. 49, 823–830 (2014).

    Article  PubMed  Google Scholar 

  24. Wang, D. et al. Screening of undernutrition in children with Hirschsprung disease using preoperative anthropometric parameters: a multicenter cross-sectional study. JPEN J. Parenter. Enter. Nutr. 47, 151–158 (2023).

    Article  CAS  Google Scholar 

  25. Ahmad, H. et al. Evaluation and treatment of the post pull-through Hirschsprung patient who is not doing well; update for 2022. Semin. Pediatr. Surg. 31, 151164 (2022).

    Article  PubMed  Google Scholar 

  26. Langer, J. C. et al. Guidelines for the management of postoperative obstructive symptoms in children with Hirschsprung disease. Pediatr. Surg. Int. 33, 523–526 (2017).

    Article  CAS  PubMed  Google Scholar 

  27. Saadai, P. et al. Guidelines for the management of postoperative soiling in children with Hirschsprung disease. Pediatr. Surg. Int. 35, 829–834 (2019).

    Article  CAS  PubMed  Google Scholar 

  28. Aworanti, O. M., McDowell, D. T., Martin, I. M. & Quinn, F. Does functional outcome improve with time postsurgery for Hirschsprung disease? Eur. J. Pediatr. Surg. 26, 192–199 (2016).

    PubMed  Google Scholar 

  29. Temple, S. J., Shawyer, A. & Langer, J. C. Is daily dilatation by parents necessary after surgery for Hirschsprung disease and anorectal malformations? J. Pediatr. Surg. 47, 209–212 (2012).

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This work was supported by The Natural Science Foundation of China (81801496), and Nanjing Special Fund for Health Science and Technology Development (YKK21147).

Author information

Author notes

  1. These authors contributed equally: Hang Lu, Jie Tang.

Authors and Affiliations

  1. Department of Pediatric Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu, China

    Hang Lu, Jie Tang, Changgui Lu & Weibing Tang

  2. Office of Clinical Research, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu, China

    Wei Li

Authors
  1. Hang Lu
    View author publications

    Search author on:PubMed Google Scholar

  2. Jie Tang
    View author publications

    Search author on:PubMed Google Scholar

  3. Changgui Lu
    View author publications

    Search author on:PubMed Google Scholar

  4. Wei Li
    View author publications

    Search author on:PubMed Google Scholar

  5. Weibing Tang
    View author publications

    Search author on:PubMed Google Scholar

Contributions

Study design: W.B.T., J.T., H.L. Data collection: H.L., J.T., C.G.L. Statistical analysis: H.L., J.T., W.L. Writing of the first draft of the manuscript: H.L., J.T. Manuscript revision: W.B.T., J.T.

Corresponding author

Correspondence to Weibing Tang.

Ethics declarations

Competing interests

The authors declare no competing interests.

Informed consent

Informed consent was obtained from the parents or guardians.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lu, H., Tang, J., Lu, C. et al. For short-segment Hirschsprung disease, daily trans-anal irrigation before pull-through surgery is necessary?. Pediatr Res 98, 224–230 (2025). https://doi.org/10.1038/s41390-024-03730-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue date:

  • DOI: https://doi.org/10.1038/s41390-024-03730-2

Search

Advanced search

Quick links