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Published on: April 26, 2019
Prevalence and Factors associated with Bowel Dysfunctions after Pull-Through Surgery in Children Diagnosed with
Maliwan Surasen1, Palittiya Sintusek1,2, Nimmita Srisan2,3
1Department of Pediatrics, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Insights
Bowel dysfunction is common after surgery for Hirschsprung disease (HD), affecting nearly 65% of patients. Preoperative enterocolitis and early surgery are linked to poorer outcomes.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Research
Background:
- Hirschsprung disease (HD) is a congenital condition requiring surgical correction via pull-through procedures.
- Postoperative bowel dysfunction, including enterocolitis, constipation, and incontinence, is a significant concern for patients with HD.
- Understanding the prevalence and risk factors for bowel dysfunction is crucial for improving long-term outcomes.
Purpose of the Study:
- To determine the prevalence of bowel dysfunction after pull-through surgery in children with Hirschsprung disease.
- To identify factors associated with the development of postoperative bowel dysfunction.
Main Methods:
- Retrospective review of medical records for children under 18 diagnosed with HD between 2004 and 2022.
- Categorization of bowel dysfunction into Hirschsprung-associated enterocolitis (HAEC), constipation, and fecal incontinence.
- Statistical analysis to identify factors associated with bowel dysfunction, including preoperative conditions and surgical techniques.
Main Results:
- The overall prevalence of bowel dysfunction was 64.95% during an average follow-up of 8.33 years.
- Hirschsprung-associated enterocolitis (HAEC) was the most frequent issue (46.39%), followed by nonretentive incontinence (22.68%) and constipation (20.62%).
- Preoperative HAEC, Duhamel operation, and pull-through surgery before 6 months of age were significantly associated with increased risk of bowel dysfunction.
Conclusions:
- Despite successful pull-through surgery, bowel dysfunction remains a prevalent complication in children with Hirschsprung disease.
- Preoperative HAEC, the Duhamel surgical approach, and early pull-through surgery (before 6 months) are independent risk factors for long-term bowel dysfunction.
- Further research and tailored management strategies are needed to mitigate these postoperative complications.
Purpose:
This study investigated the prevalence of bowel dysfunction and associated factors after pull-through surgery.
Methods:
The medical records of children under 18 years old diagnosed with Hirschsprung disease (HD) based on histopathology between 2004 and 2022 were reviewed. Bowel dysfunction after pull-through surgery was categorized into Hirschsprung-associated enterocolitis (HAEC), constipation, and fecal incontinence.
Results:
Among 97 children diagnosed with HD, the median age at presentation was 3 (2-15) days (84.54% male). The clinical manifestations included abdominal distension (58.76%), constipation (17.52%), bilious vomiting (17.52%), nonbilious vomiting (14.43%), and enterocolitis (12.37%). HDs were classified by the location of aganglionosis: short segments (74.23%), long segments (8.25%), total colonic (12.37%), and small intestinal (5.15%). Excluding surgical complications, the prevalence of bowel dysfunction was 64.95% during an average follow-up of 8.33 years. HAEC was the most common issue (46.39%), followed by nonretentive incontinence (22.68%), constipation (20.62%), and retentive incontinence (15.46%). Preoperative HAEC was significantly associated with post-surgery HAEC (adjusted odds ratio [aOR] 18.31; 95% confidence interval [CI], 1.30-257.73; p=0.031). The Duhamel operation was associated with constipation and retentive incontinence (aOR 62.15; 95% CI, 1.64-2,349.13; p=0.026). Age under 6 months at pull-through surgery was associated with nonretentive fecal incontinence after 4 years (aOR 8.83; 95% CI, 1.11-70.39; p=0.040).
Conclusion:
The prevalence of bowel dysfunction in children with HD remains high despite successful surgical correction. Preoperative HAEC, Duhamel operation, and pull-through surgery before the age of 6 months were found to be independent factors associated with bowel dysfunction after pull-through surgery.
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