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Does Functional Outcome Improve with Time Postsurgery for Hirschsprung Disease?

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European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery ... [Et Al] = Zeitschrift Fur Kinderchirurgie
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Functional outcomes after Hirschsprung disease (HD) surgery improve over time, with continence improving significantly. However, constipation remains a persistent issue following endorectal pull-through procedures for HD.

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Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Clinical Outcomes Research

Background:

  • Hirschsprung disease (HD) is a congenital disorder characterized by the absence of ganglion cells in the distal colon, leading to functional obstruction.
  • Pull-through surgery is the standard treatment for HD, but postoperative constipation and incontinence are common complications.
  • Long-term data on functional outcomes, particularly after newer endorectal pull-through techniques, are limited.

Purpose of the Study:

  • To evaluate the long-term functional outcomes after endorectal pull-through surgery for Hirschsprung disease.
  • To determine if improvements in continence and constipation occur over time following this surgical approach.
  • To identify factors associated with improved functional outcomes.

Main Methods:

  • A cohort of 51 children who underwent transabdominal or transanal endorectal pull-through for HD were assessed using the validated Pediatric Incontinence and Constipation Scoring System (PICSS).
  • Exclusion criteria included total colonic aganglionosis and Down syndrome.
  • Linear regression analysis was used to correlate PICSS scores with follow-up duration, and demographic comparisons were made between children with and without persistent symptoms.

Main Results:

  • Incontinence scores in children over 35 months showed a positive correlation with follow-up duration (p=0.03), suggesting improvement in continence over time.
  • Constipation scores were not significantly related to follow-up duration (p=0.486).
  • Children with improved continence had a longer mean follow-up duration compared to those with incomplete continence (111.64 vs. 69.19 months, p=0.051), while follow-up duration did not differ between constipated and non-constipated groups.

Conclusions:

  • Endorectal pull-through surgery for Hirschsprung disease is associated with improved continence over time.
  • Constipation frequently persists as a long-term issue despite surgical intervention.
  • Further research may be needed to address persistent constipation after HD surgery.