Association of probiotics combined with glutamine with postoperative outcomes in children with Hirschsprung disease: a retrospective propensity score-matched cohort study

Objective To evaluate the association between postoperative use of probiotics combined with glutamine and intestinal function recovery, Hirschsprung disease-associated enterocolitis (HAEC), nutritional status, and immune-inflammatory indicators following radical surgery for Hirschsprung disease (HD). Methods This retrospective observational cohort study included children who underwent radical surgery for HD at our hospital between January 2023 and December 2025. According to the actual postoperative regimen received, patients were divided into an observation group receiving probiotics combined with glutamine in addition to conventional postoperative management ( n = 46) and a control group receiving conventional postoperative management alone without the probiotic preparation or glutamine supplementation used in the observation group ( n = 48). A 1:1 propensity score matching (PSM) was performed to reduce confounding from measured baseline characteristics and improve covariate balance between the non-randomized treatment groups, resulting in 40 matched pairs. Postoperative recovery of bowel sounds, time to first defecation, length of hospital stay, HAEC incidence at 6 months postoperatively, and changes in nutritional markers (albumin, prealbumin, transferrin), peripheral blood T lymphocyte subsets (CD4⁺, CD4⁺/CD8⁺ ratio), and inflammatory cytokines (IL-10, IL-6) were compared between the two groups. Results After PSM, the observation group exhibited significantly shorter times for recovery of bowel sounds, first defecation, and hospital stay compared to the control group [(22.5 ± 7.8) h vs. (34.6 ± 9.5) h, (38.5 ± 10.1) h vs. (51.8 ± 12.5) h, (10.5 ± 3.0) d vs. (14.4 ± 4.2) d, all P < 0.001]. At 6 months postoperatively, the incidence of HAEC was lower in the observation group than in the control group [10.0% (4/40) vs. 32.5% (13/40), P = 0.014]. Baseline nutritional, inflammatory, and cellular immune indicators were comparable between the matched groups (all P > 0.05). From baseline to 3 months, the observation group showed greater increases in albumin, prealbumin, transferrin, IL-10, CD4 percentage, and CD4/CD8 ratio and a greater decrease in IL-6 than the control group (all P < 0.001). Conclusion In this retrospective observational cohort, postoperative use of probiotics combined with glutamine was associated with earlier intestinal function recovery, shorter hospitalization, a lower incidence of HAEC, and more favorable nutritional, cellular immune, and inflammatory indicators after PSM. These findings should be interpreted as associations rather than evidence of a causal treatment effect and require confirmation in prospective randomized studies.