Post pull- through bowel function outcome and contributing factors in children; a cross-sectional study from low...

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Pediatric Gastroenterology

Background:

• Hirschsprung'The Hirschsprung's disease (HSD) is a congenital disorder characterized by the absence of ganglion cells in the distal colon, leading to intestinal obstruction.
• The "pull-through" procedure is the standard surgical treatment for HSD, but it is associated with significant short-term and long-term complications.
• Limited data exists on the long-term bowel function outcomes in children who have undergone pull-through surgery, especially those beyond the typical toilet-training age.

Purpose of the Study:

• To evaluate the bowel function outcomes in children diagnosed with Hirschsprung's disease (HSD) who have undergone pull-through surgery.
• To investigate the bowel function in a specific cohort of patients aged three years and older, who are past the typical age for toilet training.
• To identify potential correlations between surgical factors and long-term bowel function.

Main Methods:

• A cross-sectional study was conducted involving 58 children aged three years or older, at least six months post-pull-through surgery.
• Data on bowel function was collected and analyzed using the Statistical Package for the Social Sciences (SPSS Version 26).
• Fischer's exact test was employed to assess the association between variables and bowel function outcomes, with a 95% confidence interval and a significance level of P < 0.05.

Main Results:

• The study included 58 children (70.7% male), with a median age of 3.9 years. Most presented with chronic constipation.
• Only 25% of patients reported normal bowel habits and full continence; 56.9% experienced fecal soiling, and 44.8% reported constipation.
• A significant association was found between extensive colonic resection (proximal to the splenic flexure) and adverse bowel function outcomes (P=0.049).

Conclusions:

• A significant proportion of children experience persistent bowel dysfunction after pull-through surgery for Hirschsprung's disease.
• Early diagnosis of HSD and the use of frozen section biopsy during surgery could potentially reduce the extent of colon resection and improve outcomes.
• Further large-scale, multicenter studies are recommended to identify predictive factors for adverse bowel function outcomes post-pull-through surgery.