Long-term Follow-up of Patients with Hirschsprung Disease: Unusual Late Complications After Pull-through

Document Type : Research/Original Article

Authors

1 Pediatric Surgery Research Center, Research Institute for Children’s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Pediatric Gastroenterology, Hepatology, and Nutrition Research Center, Research Institute for Children’s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Background:
A large number of patients who underwent pull-through surgery due to Hirschsprung's disease (HD) were not followed up properly and they suffered from many complications such as fecal soiling, constipation, and etc. Although some of these complications may relief over time, it is rational to consider an evaluative protocol to identify anatomical or pathological complications in these patients. Objective:
The aim of the present study is to evaluate and introduce these catastrophic complications.
Method:
In this historical cohort study, 193 patients with HD who had undergone pull- through surgery between 2006 to 2013 were considered. All files and questionnaires were used to collect patients' information and patients were physically examined individually. The mean duration of the follow-up was 96.4±17.2 months ranging from 60 to 144 months The follow-up performed for all patients via the outpatient clinics or by telephone. All statistical information was analyzed by SPSS software version 17.
Results:
Results:
At first presentation, intestinal obstruction was more frequent than constipation. The most common involved segment was in rectosigmoid. The most common early postoperative complication was stricture in anal canal and the most common late complications were constipation and focal soiling.
Conclusion:
Although surgical advancements, a large number of patients underwent surgical procedures due to HD experience long term complications. Surgical treatment of HD generally present with high-quality outcome and the majority of children survive in satisfactory situation for long time but occasionally pediatric surgeons meet head-on catastrophic complication in these patients that require extended team work to be resolved

Keywords

References

1]            Khalil, M., Long-term health-related quality of life for patients with Hirschsprung’s disease at 5 years after transanal endorectal pull-through operation. Quality of Life Research, 2015. 24(11): p. 2733-2738.
[2]          De La Torre, L. and J.C. Langer. Transanal endorectal pull-through for Hirschsprung disease: technique, controversies, pearls, pitfalls, and an organized approach to the management of postoperative obstructive symptoms. in Seminars in pediatric surgery. 2010. Elsevier.
[3]          Dasgupta, R. and J.C. Langer. Transanal pull-through for Hirschsprung disease. in Seminars in pediatric surgery. 2005. Elsevier.
[4]          Neuvonen, M.I., et al., Bowel function and quality of life after transanal endorectal Pull-through for Hirschsprung Disease. Annals of surgery, 2017. 265(3): p. 622-629.
[5]          Neuvonen, M., et al., Lower urinary tract symptoms and sexual functions after endorectal pull-through for Hirschsprung disease: controlled long-term outcomes. Journal of pediatric surgery, 2017. 52(8): p. 1296-1301.
[6]          Aworanti, O.M., et al., Does functional outcome improve with time postsurgery for Hirschsprung disease? European Journal of Pediatric Surgery, 2016. 26(02): p. 192-199.
[7]          Rouzrokh, M., et al., What is the most common complication after one-stage transanal pull-through in infants with Hirschsprung’s disease? Pediatric surgery international, 2010. 26(10): p. 967-970.
[8]          Rouzrokh, M., et al., Can We Rely on Frozen Sections of a Rectal Biopsy for One-stage Trans-anal Pull-through Operation in Hirschsprung's Disease? Iranian journal of pediatrics, 2011. 21(1): p. 72.
[9]          Zimmer, J., C. Tomuschat, and P. Puri, Long-term results of transanal pull-through for Hirschsprung’s disease: a meta-analysis. Pediatric surgery international, 2016. 32(8): p. 743-749.
[10]        Jarvi, K., et al., Bowel function and gastrointestinal quality of life among adults operated for Hirschsprung disease during childhood: a population-based study. Annals of surgery, 2010. 252(6): p. 977-981.
[11]        Heikkinen, M., R. Rintala, and I. Louhimo, Bowel function and quality of life in adult patients with operated Hirschsprung's disease. Pediatric surgery international, 1995. 10(5-6): p. 342-344.
[12]        Yang, L., et al., Transanal endorectal pull-through for Hirschsprung’s disease using long cuff dissection and short V-shaped partially resected cuff anastomosis: early and late outcomes. Pediatric surgery international, 2012. 28(5): p. 515-521.
[13]        Catto‐Smith, A.G., M. Trajanovska, and R.G. Taylor, Long‐term continence after surgery for Hirschsprung's disease. Journal of gastroenterology and hepatology, 2007. 22(12): p. 2273-2282.
[14]        Rintala, R.J. and M.P. Pakarinen. Long-term outcomes of Hirschsprung's disease. in Seminars in pediatric surgery. 2012. Elsevier.
[15]        Khaleghnejad Tabari, A., et al., State’s pull-throug for total colonic aganglionosis and GI dismotility. Arch Iran Med, 2013. 16: p. 277-80.
[16] Bei-lei Yan, MDa, Le-wee Bi, MDa, Qian-yu Yang, MDa, Xue-si Wu, MBb, Hua-lei Cui, MD, PhDc Transanal endorectal pull-through procedureversus transabdominal surgery for Hirschsprungdisease Medicine (2019) 98:32
Iranian Journal of Colorectal Research
Volume 8, Issue 4
December 2020
Pages 175-180

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