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Long-term stooling patterns in infants undergoing primary endorectal pull-through for Hirschsprung's disease
D H Teitelbaum1, R A Drongowski, J N Chamberlain
1University of Michigan Medical Center and the C.S. Mott Children's Hospital, Ann Arbor 48109, USA.
Insights
Primary endorectal pull-through (ERPT) surgery for Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatal Care
Background:
- Hirschsprung's disease is a congenital condition affecting the large intestine.
- Primary endorectal pull-through (ERPT) is a common surgical approach for infants.
- Long-term outcomes of ERPT in infants require further evaluation.
Purpose of the Study:
- To assess long-term stooling patterns and continence in infants after primary ERPT.
- To evaluate the efficacy of ERPT for Hirschsprung's disease in young patients.
Main Methods:
- Retrospective review of 24 infants undergoing primary ERPT for Hirschsprung's disease.
- Detailed interviews with families of patients over 3 years old to assess continence (0-10 scale).
- Analysis of stooling frequency trends and complication rates (enterocolitis).
Main Results:
- Mean follow-up was 1,036 days; mean age at ERPT was 15 days.
- Stooling frequency normalized rapidly within 6 months post-ERPT.
- Continence was rated good to excellent in 10 patients, fair in 2 (with total colonic disease).
- Nine patients experienced 20 episodes of enterocolitis.
Conclusions:
- Primary ERPT in infants with Hirschsprung's disease leads to favorable long-term stooling patterns.
- Good to excellent continence rates are achievable with primary ERPT.
- ERPT is an effective surgical option for managing Hirschsprung's disease in neonates and young infants.
Abstract:
Primary endorectal pull-through (ERPT) has become an increasingly popular method of caring for neonates and young infants who have Hirschsprung's disease. This study evaluated the long-term stooling patterns and continence rates of patients who had a primary ERPT as a young infant. The records of 24 infants who underwent a primary ERPT for Hirschsprung's disease were reviewed. The patients' families (those patients over 3 years of age, n = 12) underwent a detailed interview that graded continence from 0 (poor) to 10 (normal). Mean age at ERPT was 15 +/- 17 days (range, 2 to 67). Mean follow-up was 1,036 +/- 614 days. Nine patients suffered from 20 episodes of enterocolitis. Stooling frequency declined rapidly in the first 6 months after the ERPT (r2 = 1.00) and more slowly after this time (r2 = 0.79). Continence was graded as normal (10) in one, good (6 to 9 points) in nine, and fair (1 to 5) in two patients, both of whom had total colonic disease. The authors conclude that a primary ERPT in the young infant who has Hirschsprung's disease can yield excellent results including normalization of stooling frequency and good to excellent levels of continence.