Bananagram: an alternative to distal loopogram prior to colostomy closure for Hirschsprung disease.

Background: This study aimed to investigate if mashed ripe bananas (bananagram) could be used to assess the integrity of the gut before transverse colostomy closure in patients with Hirschsprung disease (HSCR) in a low- and middle-income country tertiary-level hospital. Methods: This is a prospective, single-center, hospital-based cohort study. A feeding tube tip was inserted about 5-8 cm through the distal loop, and 15 mL of mashed banana was introduced. The amount introduced and the spontaneous expulsion of mashed banana were measured. We also measured colonic transit time (CTT), input and expulsion ratio, color of the expulsed banana stream, size of the banana stream passed through the anus and clinical signs of bowel obstruction or perforation after the procedure. Results: From January 2018 to June 2023, 266 HSCR patients with a transverse colostomy were included. The mean±standard deviation (SD) age was 26.45±6.41 months. The median CTT of mashed banana was 8 min (interquartile range (IQR): 4-13 min). The mean amount of mashed banana spontaneously expelled through the anus was 13.25±0.95 mL. More than 90% of patients expelled unchanged mashed bananas, and 9.4% expelled stool-banana mixtures. Banana stream was 0.3-1.5 cm in 257 patients and <0.3 cm in nine patients. These nine patients needed revision pull-through. Conclusion: Bananagram can be performed at the bedside. It is easy to perform, cost-effective, available throughout the year and does not pose radiation hazards.