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Assessment of defecation function beyond infantile period for transanal single-stage endorectal pull-through in
Soo-Hong Kim1, Yong-Hoon Cho1, Hae-Young Kim2
1Division of Pediatric Surgery, Department of Surgery, Pusan National University Yangsan Hospital and Pusan National University Children's Hospital, Yangsan, Korea.
Insights
The transanal single-stage endorectal pull-through (TERPT) procedure for Hirschsprung disease (HD) shows favorable long-term functional outcomes. Bowel function and social problems in patients treated with TERPT improve with age and are comparable to the normal population.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Outcomes Research
Background:
- Hirschsprung disease (HD) is a congenital condition affecting the large intestine.
- The transanal single-stage endorectal pull-through (TERPT) procedure is a common surgical approach for HD.
- While TERPT offers favorable outcomes, persistent bowel dysfunction and fecal incontinence can occur.
Purpose of the Study:
- To evaluate the mid- and long-term functional outcomes of TERPT in patients with Hirschsprung disease.
- To assess outcomes after TERPT performed during infancy, post-toilet training completion.
- To compare functional results with a normal population.
Main Methods:
- Retrospective review of 82 patients (aged ≥4 years) who underwent TERPT for HD between 2001 and 2013.
- Functional outcomes assessed using the Bowel Function Score (BFS) questionnaire.
- Statistical analysis using a one-sample t-test compared to normal values.
Main Results:
- Bowel Function Score (BFS) was consistent across age groups.
- Fecal soiling and social problems were initially lower in HD patients but normalized by age 7.
- Stool frequency decreased over time and was not significantly different between groups.
Conclusions:
- TERPT performed during infancy post-toilet training yields functional outcomes comparable to the general population.
- Symptomatic discomfort and functional deficits generally diminish with age.
- TERPT is an effective surgical treatment for Hirschsprung disease with good long-term results.
Purpose:
Transanal single-stage endorectal pull-through (TERPT) procedure for patients with Hirschsprung disease (HD) has favorable outcomes, with a lower complication rate. Nevertheless, various degrees of bowel dysfunction and fecal incontinence can persist for a long time in some patients. The aim of this study was to assess the mid- and long-term outcomes of TERPT performed during the infantile period after the completion of toilet training.
Methods:
We retrospectively reviewed 82 patients aged ≥4 years who underwent TERPT during the infantile period after the pathological diagnosis of HD between 2001 and 2013. Functional outcomes were investigated according to the answers of the Bowel Function Score (BFS) questionnaire, a previously validated 7-item questionnaire about bowel habits. Normal values were obtained in a previous study on BFS for children in Western countries, and a one-sample t-test was used for statistical analysis.
Results:
Overall, BFS was similar in all investigated age groups. On comparing fecal soiling and social problems between the HD and normal populations, a lower score at an early age in patients with HD was noted; however, the scores became similar when the patients were 7 years of age. Stool frequency decreased continuously but was not significantly different between the 2 groups.
Conclusion:
The functional outcomes of TERPT performed during the infantile period, after completing toilet training, were similar to that of the normal population. In most cases, uncomfortable symptoms were diminished and functions improved with age.
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