Assessment of Surgical Outcomes in Patients With Hirschsprung Disease: A 20-year Experience

Hirschsprung disease (HD) is one of the most common congenital intestinal anomalies in infants. Despite advances in surgical techniques, the postoperative morbidity rate remains high. The objective of this study was to report our experience in managing patients with HD in a developing country and to identify potential predictive risk factors associated with postoperative complications.

A multicenter retrospective study was conducted involving children who underwent surgery for HD between January 1, 2000, and December 31, 2019. All clinical outcomes and potential risk factors were thoroughly analyzed. Patients with associated anomalies or incomplete medical records were excluded. Data were analyzed using SPSS v.23, with a significance level set at p < 0.05.

A total of 174 children were included in the study, with a minimum follow-up period of three years. All patients underwent a modified Yancey-Soave pull-through procedure. Postoperative complications occurred in 100 patients, representing a complication rate of 57.47 %. These included anastomotic complications in 43 patients (24.7 %), constipation in 29 patients (16 %), and incontinence in 62 patients (35 %). Notably, 92 patients (52.8 %) were older than 1 year at the time of surgery, indicating high proportion of late surgical interventions. Variables such as gender, age, familial form, preoperative biopsy, disease extent, and surgical approach were not statistically associated with postoperative complications. However, an operative age greater than one year was significantly associated with an increased risk of unplanned reoperations (p = 0.022, OR = 3.5; 95 % CI: 1.1-11.1), while younger operative age was significantly associated with a higher risk of late stenosis (p = 0.013, OR = 3.1; 95 % CI: 1.18-8.30).

Our study demonstrates that a later operative age older than one year is significantly associated with a higher risk of unplanned reoperations, whereas an earlier operative age is significantly associated with a greater risk of late stenosis.