Rates of post-operative complications in Hirschsprung Disease: A study by the Canadian Consortium for Research in Pediatric Surgery (CanCORPS) with suggested management-based stricture classification.

PURPOSE: Morbidity and mortality following surgery for Hirschsprung disease (HD) vary widely in the literature and largely emanate from single center studies. We conducted a population-based study of postoperative complication rates in Canadian children. METHODS: A multi-centre, retrospective review of children with HD from six Canadian children's hospitals was performed. Data was collected between 2010 and 2022. Patients were included if they had at least six months of follow-up. RESULTS: The study cohort included 227 patients. The median age at diagnosis was 1 week (interquartile range [IQR]:1-2) and 81.0% were male. The median age at time of pull-through was two months (IQR:1-7). The most common surgical approach was laparoscopic (63.2%), with the remaining procedures being transanal (27.3%), and open (9.5%). The rate of reoperation was 31.3%, of which 63.4% were minor procedures and 36.6% were major procedures. The rate of readmission was 41.4%, with the most common reason being Hirschsprung-associated enterocolitis (HAEC) (30.0%). Surgery-specific complications occurred in 15.0% of patients. These included stricture at 12-weeks (6.2%), anastomotic leak (0.9%), and HAEC (17.2%). Complication rates did not differ between patients who underwent surgery before or after one month of age. CONCLUSION: In this Canadian population-based study, significant rates of reoperation and readmission were found, despite overall low rates of complications (HAEC, stricture and leak). A new management-based classification of stricture is proposed to aid in stratification of patients. Prospective studies will aim to validate this approach and provide more meaningful rates of postoperative complications following pull-through for HD.