Gastrointestinal function after surgical correction of Hirschsprung's disease: long-term follow-up in 135 patients

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Clinical Outcomes Research

Background:

• Hirschsprung's disease is a congenital condition affecting the large intestine.
• Surgical intervention is the primary treatment for Hirschsprung's disease.
• Long-term outcomes, particularly regarding fecal soiling, require further investigation.

Purpose of the Study:

• To evaluate the long-term functional outcomes of surgical reconstruction for Hirschsprung's disease in children.
• To identify the incidence and severity of fecal soiling after different surgical techniques.
• To analyze factors influencing residual functional problems.

Main Methods:

• Retrospective review of 177 pediatric patients undergoing definitive surgical reconstruction for Hirschsprung's disease over 22 years.
• Data collection included demographics, surgical procedures, and clinical follow-up information from 135 patients (78%).
• Analysis of functional outcomes, focusing on fecal soiling, stratified by surgical technique and patient characteristics.

Main Results:

• The modified Duhamel procedure was the most common (67%), followed by endorectal pull-through (21%).
• Overall, 12.6% of patients reported severe fecal soiling, with higher rates in those with total colonic aganglionosis undergoing side-to-side anastomosis (40%).
• No statistically significant difference in soiling was found between endorectal pull-through and modified Duhamel procedures.

Conclusions:

• Surgical reconstruction generally provides near-normal gastrointestinal function for most children with Hirschsprung's disease.
• Significant long-term issues with fecal soiling persist in a notable percentage of patients, particularly after specific procedures for extensive disease.
• Outcomes highlight the need for continued monitoring and potential refinement of surgical strategies for Hirschsprung's disease.