[Rectal irrigation and bowel decontamination for the prevention of postoperative enterocolitis in Hirschsprung's disease].

UNLABELLED: The object is to determine the utility of rectal irrigation (RI) and bowel decontamination for the prevention of postoperative enterocolitis in Hirschsprung's disease.

MATERIAL AND

METHODS

Between 1978 and 2005, 37 patients underwent surgical treatment for Hirschsprung's disease. Group 1 (1978-1993): 19 patients, 17 with rectosigmoid or long segment disease, and 2 total colonic aganglionosis (TCA). No postoperative prevention was used. Group II (1994-2005): 18 patients, 11 with rectosigmoid or long segment disease, and 7 TCA. Postoperative rectal irrigation (RI) and bowel decontamination was used. The RI volume was at least 10 ml/kg body weight. It was initiated on postoperative day 10, once a day for two months in the short segments, extending to 1 or more years in patients with iloeocoloplasty. Bowel decontamination, with a duration similar to the RI, was with metronidazol, gentamicin, or nistatin alternatingly. The incidence of enterocolitis, and the morbidity and mortality were evaluated in both groups.

RESULTS

In Group I, 9 patients (47%) developed postoperative enterocolitis; 1 patient, with serious preoperative enterocolitis, required digestive rest for 10 days, with parenteral feeding and intravenous antibiotics. The 2 TCA patients, one treated by the L. Martin technique, and the other, with Down's syndrome, by the Kimura technique, suffered recurrent episodes of enterocolitis, with hospitalization, intravenous antibiotic therapy, and RI. In Group I, there were 2 deaths, one related to the postoperative enterocolitis. In Group II, each of 2 patients (11%) with TCA treated by Boley-type ileocoloplasty, with preoperative enterocolitis, had 1 episode of enterocolitis during treatment; one had a further episode after suspension of the treatment. Two patients of this group suffered enterocolitis before beginning the treatment. There was no mortality in this group.

CONCLUSIONS

Rectal irrigation and bowel decontamination significantly decreased the incidence and severity of enterocolitis in Hirschsprung's disease by preventing faecal stasis and uncontrolled bacterial growth.