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.