Table 2 Recommendations for who should operate on patients with HSCR
From: ERNICA guidelines for the management of rectosigmoid Hirschsprung’s disease
Patients with HSCR should undergo pull-through surgery in centres with at least two pediatric colorectal surgeons and pathological, radiological and anesthetic expertise, including pediatric and neonatal intensive care and specialized nursing 24/7. • Concentration of interdisciplinary experience is associated with better outcomes in complex or rare pediatric surgical conditions. • Accurate primary assessment of the disease phenotype in HSCR permits appropriate surgical management • The need for re-do surgery is low in centres that regularly manage HSCR and complications are appropriately identified and managed | Level of evidence III Strength of recommendation: Strong, for Level of agreement: 100% |
Centres performing pull-through surgery for HSCR should have the capabilities to manage the entire care pathway • This includes management of surgical complications and primary surgical management of all forms of HSCR, provision of multidisciplinary care until adulthood, and specialist nursing • Ability to deliver comprehensive follow-up until adulthood, including provision of transition of care | Level of evidence III Strength of recommendation: Strong, for Level of agreement: 100% |
Centres that operate on HSCR patients should demonstrate active involvement in quality control and improvement • Maintaining prospective registries permits assessment and monitoring case volumes and outcomes • Commitment to training surgeons, pathologists and nurse practitioners in diagnostics and management of HSCR ensures continuity of local expertise • Up-to-date care practices and understanding of the disease process through networking and participation in continued medical and surgical education • Information should be given about the availability of patient support organizations as early as possible, and patients should be informed about the availability of current guidelines | Level of evidence III Strength of recommendation: Strong, for Level of agreement: 100% |