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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%