Effectiveness of Irrigation Frequency Per Rectal on Intestinal Microbiota Colonies in Hirschsprung Associate Enterocolitis Patients

Shalita Dastamuar (General Surgery Department, Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia)
Cesario Budi Prayitno (General Surgery Department, Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia)
Phey Liana (Clinical Pathology Department, Dr. Mohammad Hoesin General Hospital, Palembang, Indonesia)
Theodorus M (Medical Faculty, Universitas Sriwijaya, Palembang, Indonesia)

Sriwijaya Journal of Surgery
Vol. 5 No. 1 (2022): Sriwijaya Journal of Surgery

Introduction. Hirschsprung-associated enterocolitis (HAEC) is the most common life-threatening complication of Hirschsprung's disease. The incidence of HAEC ranges from 6-60% before and 25-37% after surgery. Rectal irrigation with warm 0.9% NaCl has been shown to reduce the incidence of HAEC before and after surgery. Rectal irrigation plays a role in preventing faecal stasis by evacuating feces, as well as reducing bacterial colonies in HAEC patients. This study aims to determine the effectiveness of rectal irrigation with warm 0.9% NaCl on the number of intestinal microbiota colonies in Hirschsprung-associated enterocolitis patients at Dr. Mohammad Hoesin Hospital Palembang. Method: A randomized clinical trial without comparison in the form of an add on trial, open label which is an experiment by providing additional measures to a group with the same standard and different treatment. Patients were divided into three groups, including antibiotics ampicillin, ceftriaxone, metronidazole and 0.9% NaCl irrigation 1 time per 24 hours (Group 1), per 12 hours (Group 2), and per 8 hours (Group 3). Comparisons were tested using paired T-test or Wilcoxon's, p-value <0.05 was considered statistically significant. Results: HAEC patients who received irrigation treatment 1 time, the number of bacterial colonies did not change, in patients with irrigation treatment 2 times the number of colonies decreased by 171,428.57 ± 138,013.11 colonies/ml, while in patients with irrigation treatment 3 times the number of colonies was reduced. colonies decreased by 214.285.71 ± 177.281.05 colonies/ml. There was a significant difference in the number of bacterial colonies before and after irrigation treatment with a frequency of 2 times (p = 0.026) and 3 times (p = 0.027) while with a frequency of 1 time there was no difference in the number of bacterial colonies before and after treatment (p = 1,000). Conclusion: Rectal irrigation with warm NaCl 0.9% as much as 20 ml/kg with a frequency of 2 times was effective in reducing the number of gut microbiome colonies. There was no significant difference in the number of bacterial colonies between the 2 and 3 times irrigation frequency groups.