Clavien-Dindo Classification And Influencing Factors Analysis Of Complications After Laparoscopic-Assisted Modified Soave Procedure For Hirschsprung Disease

Objective: To investigate the Clavien-Dindo(CD)classification and factors influencing short-term complications(≤30 days)after laparoscopic-assisted modified Soave procedure for Hirschsprung Disease(HSCR).Methods: The clinical data of patients who underwent laparoscopic-assisted modified Soave procedure in our hospital between January 2010 and December 2020 were retrospectively analyzed.Patients were subdivided into a complication group and a noncomplication group according to the occurrence of short-term postoperative complications.The general conditions of patients(gender,age,reason for first visit,clinical type,whether small bowel colitis(HAEC)occurred before surgery,whether fistula was created before surgery,whether anemia occurred before surgery,and whether hypoproteinemia occurred before surgery)and the conditions of patients’ surgery(age at surgery,duration of surgery,interpretative bleeding,and duration of postoperative hospitalization)were collected.The severity of short-term postoperative complications was assessed and analyzed by applying the CD grading system,and the above-mentioned factors that may affect complications were analyzed universally,and the indicators of statistically significant differences in the university analysis were analyzed by multifactorial logistic regression.Result: A total of 112 patients were enrolled in the study,83(74.1%)males and 29(25.9%)females,including 19(17.0%)in the complication group and 93(83.0%)in the noncomplication group.22 sub-complications took place in the 19 complications group,including 2 complications in 3 patients.22 subcontracting specifics: 2 cases of perianal skin erosion(9.1%),abdominal wound infection in 1 case(4.6%),sepsis in 1 case(4.6%),abdominal infection in 1 case(4.6%),HAEC in 9 cases(40.9%),HAEC with intestinal perforation in 2 cases(9.1%),umbilical wound dehiscence with large omental exposure in 1case(4.6%),adhesive intestinal obstruction in 3 cases(13.64%),rectal retraction in 1 case(4.55%),and acute respiratory failure with laryngeal edema in 1 case(4.6%).Postoperative Complications CD Classification: Grade I 3 cases(13.6%),Grade II 11 cases(50.0%),Grade IIIb 7 cases(31.8%),and grade IVa 1 case(4.6%).The results of univariate analysis showed that preoperative fistula(P=0.029),preoperative anemia(P=0.025)and preoperative hypoproteinemia(P<0.001)were possible influencing factors for the occurrence of postoperative complications in patients.Multifactorial logistic analysis showed that:preoperative fistula(OR=4.826,95%CI=1.187-20.162,P=0.028)and preoperative hypoproteinemia(OR=9.14,95%CI=2.678-30.972,P<0.001)were independent risk factors for the development of postoperative complications.Conclusions: The incidence of early postoperative complications after laparoscopicassisted modified Soave operation mostly belong to CD-II grade.Postponement of radical HSCR when patients develop preoperative anemia and hypoproteinemia reduces the number of early postoperative complications.When patients are in very good general condition,a stage I laparoscopic-assisted modified Soave approach for HSCR is safe and feasible.