The PODCAST-question: postoperative dilation versus calibration after surgical treatment of Hirschsprung's disease-what is necessary?

PURPOSE: Postoperative anal dilation after surgery for Hirschsprung disease (HD) still remains common practice. This study aimed to evaluate the benefit of routine dilations compared with a single postoperative calibration. METHODS: Patients who underwent HD surgery within the first year of life at the University Children’s Hospital Zurich or the University Hospital Frankfurt were retrospectively reviewed. Two groups were compared: those with serial postoperative dilations (PD) and those with a single calibration (PC). Primary outcomes included anastomotic stricture, Hirschsprung-associated enterocolitis (HAEC), and constipation/fecal incontinence. RESULTS: A total of 91 patients were included—46 (51%) in the PD group and 45 (49%) in the PC group. Strictures occurred in 5 patients (10.9%) with PD and 9 (20%) with PC (p = 0.259). HAEC developed in 5 (10.9%) PD and 6 (13.3%) PC patients (p = 0.718). Rates of constipation/fecal incontinence were similar (p = 0.67). CONCLUSION: Routine postoperative anal dilation after HD surgery does not significantly reduce the incidence of strictures, HAEC, or constipation/fecal incontinence. Single postoperative calibration appears sufficient to determine whether further dilation is necessary.