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The Patients with Hirschsprung's Disease Who Underwent Pull-Through at Age Less than 1 Year: Longitudinal Bowel
Chaeyoun Oh1, Joong Kee Youn2, Ji-Won Han2
1Department of Pediatric Surgery, Korea University College of Medicine, Seoul, Korea.
Insights
Longitudinal outcomes in Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Outcomes Research
Background:
- Hirschsprung's disease (HD) presents chronic complications including frequent stooling, fecal soiling, and constipation post-pull-through (PT).
- Understanding long-term bowel function is crucial for managing pediatric patients with HD.
Purpose of the Study:
- To investigate the longitudinal bowel function outcomes in patients under one year of age following pull-through surgery for Hirschsprung's disease.
- To compare the effects of different surgical procedures on stool frequency, soiling, and constipation over time.
Main Methods:
- Retrospective analysis of 396 patients who underwent PT for HD between 1979 and 2014.
- Stool frequency analyzed up to 10 years, and soiling and constipation up to 15 years post-surgery.
- Comparison of outcomes based on the extent of aganglionic segment (AS) resected and surgical technique (Soave vs. Duhamel procedure).
Main Results:
- Stool frequency decreased over time post-resection of the aganglionic segment (AS).
- Soave procedure (SP) was associated with increased stool frequency and soiling severity compared to the Duhamel procedure (DP), but lower constipation severity.
- Constipation severity peaked around age 5 and declined, with DP showing higher severity than SP.
Conclusions:
- Shorter aganglionic segments (AS) correlate with fewer bowel movements and less soiling, though differences diminish with age.
- The Soave procedure (SP) leads to more frequent bowel movements and soiling but less constipation compared to the Duhamel procedure (DP).
- Surgical technique significantly influences long-term bowel function outcomes in Hirschsprung's disease patients.
Background:
Frequent stooling immediately after pull-through (PT), fecal soiling, and constipation are chronic complications of Hirschsprung's disease (HD). This study aimed to investigate the longitudinal outcomes in terms of bowel function of patients below the age of 1 year undergoing PT.
Methods:
We retrospectively evaluated 396 patients who underwent PT for HD between September 1979 and March 2014. Stool frequency was analyzed up to 10 years of age, and soiling and constipation were analyzed up to 15 years of age.
Results:
After resection of the aganglionic segment (AS), stool frequency decreased over time. Furthermore, stool frequency among the three groups was similar 4 years after PT. Among the patients with aganglionic bowel resection, those who underwent the Soave procedure (SP) had an increase (0.56/day) in stool frequency than those who underwent the Duhamel procedure (DP). The soiling severity according to the AS was similar after 5 years of age. More severe soiling was better associated with patients who underwent the SP than those who underwent the DP. The constipation severity increased gradually until around 5 years and declined thereafter. More severe constipation was better associated with the DP than with the SP.
Conclusion:
The result of the analysis of stool frequency and soiling in patients with HD indicated that shorter ASs resulted in fewer bowel movements and less severe soiling. However, with the increase in patient age, the differences became similar. Compared to the DP, the SP was associated with an increased frequency of bowel movements and soiling severity; however, the constipation severity was lower.
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