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Multidisciplinary management of postoperative continence issues in rectosigmoid Hirschsprung disease: a unicentric
Marta Erculiani1, Giulia Mottadelli2, Sara Micheletto2
1Pediatric Surgery Unit, Umberto Bosio Centre for Pediatric Digestive Diseases, The Children Hospital, AOU SS Antonio e Biagio e Cesare Arrigo, Alessandria, Italy. marta.erculiani@ospedale.al.it.
Introduction:
Postoperative outcomes in Hirschsprung disease (HSCR) may be extremely variable. Therefore, an appropriate follow up is mandatory due to the dynamic nature of patients' clinical history. We aim to provide a diagnostic-therapeutic algorithm for the multidisciplinary postoperative management of rectosigmoid HSCR patients and to characterize our study population based on patients' distribution within the algorithm.
Methods:
We conducted a retrospective study including all patients with rectosigmoid HSCR treated at or referred after surgery to Umberto Bosio Center for Digestive Diseases between 2019 and 2023. Data concerning demographic and clinical features, diagnostic and therapeutic management as well as post-operative outcomes were collected. Three main functional groups were retrospectively defined (asymptomatic patients, patients with obstructive symptoms, patients with fecal incontinence/soiling). Diagnostic pathways and therapeutic strategies were analyzed for each group. The functional outcome after the rehabilitation programme was evaluated at the time of data collection.
Results:
Eighty-six patients were included, 37% of whom referred from other centers. According to the first post-operative evaluation, patients were distributed as follows: 47.7% (41/86) were asymptomatic, 19.8% (17/86) had obstructive symptoms, and 32.5% (28/86) had fecal incontinence/soiling. Following the diagnostic and therapeutic measures, all patients that were initially classified as asymptomatic were still asymptomatic, patients with obstructive symptoms decreased of more than 75% (from 17 to 4) and among patients with fecal incontinence/soiling up to 68% (19/28) proved to be socially clean.
Conclusions:
The algorithm proved to be effective for all patients even if operated elsewhere. Most patients with obstructive symptoms as well as those with fecal incontinence showed significant clinical improvement, confirming that a targeted treatment protocol can solve these conditions.
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