Pediatric Gastroenterology, Hepatology & Nutrition

The Korean Society of Pediatric Gastroenterology, Hepatology and Nutrition (대한소아소화기영양학회)
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Prevalence and Factors associated with Bowel Dysfunctions after Pull-Through Surgery in Children Diagnosed with Hirschsprung Disease

  • Maliwan Surasen (Department of Pediatrics, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Faculty of Medicine, Chulalongkorn University) ;
  • Palittiya Sintusek (Department of Pediatrics, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Faculty of Medicine, Chulalongkorn University) ;
  • Nimmita Srisan (Center of Excellence in Thai Pediatric Gastroenterology, Hepatology and Immunology, Division of Gastroenterology, Department of Pediatrics, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Faculty of Medicine, Chulalongkorn University) ;
  • Katawaetee Decharun (Center of Excellence in Thai Pediatric Gastroenterology, Hepatology and Immunology, Division of Gastroenterology, Department of Pediatrics, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Faculty of Medicine, Chulalongkorn University) ;
  • Paisarn Vejchapipat (Department of Surgery, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Faculty of Medicine, Chulalongkorn University)
  • Received : 2024.03.07
  • Accepted : 2024.07.12
  • Published : 2024.11.15
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Abstract

Purpose: This study investigated the prevalence of bowel dysfunction and associated factors after pull-through surgery. Methods: The medical records of children under 18 years old diagnosed with Hirschsprung disease (HD) based on histopathology between 2004 and 2022 were reviewed. Bowel dysfunction after pull-through surgery was categorized into Hirschsprung-associated enterocolitis (HAEC), constipation, and fecal incontinence. Results: Among 97 children diagnosed with HD, the median age at presentation was 3 (2-15) days (84.54% male). The clinical manifestations included abdominal distension (58.76%), constipation (17.52%), bilious vomiting (17.52%), nonbilious vomiting (14.43%), and enterocolitis (12.37%). HDs were classified by the location of aganglionosis: short segments (74.23%), long segments (8.25%), total colonic (12.37%), and small intestinal (5.15%). Excluding surgical complications, the prevalence of bowel dysfunction was 64.95% during an average follow-up of 8.33 years. HAEC was the most common issue (46.39%), followed by nonretentive incontinence (22.68%), constipation (20.62%), and retentive incontinence (15.46%). Preoperative HAEC was significantly associated with post-surgery HAEC (adjusted odds ratio [aOR] 18.31; 95% confidence interval [CI], 1.30-257.73; p=0.031). The Duhamel operation was associated with constipation and retentive incontinence (aOR 62.15; 95% CI, 1.64-2,349.13; p=0.026). Age under 6 months at pull-through surgery was associated with nonretentive fecal incontinence after 4 years (aOR 8.83; 95% CI, 1.11-70.39; p=0.040). Conclusion: The prevalence of bowel dysfunction in children with HD remains high despite successful surgical correction. Preoperative HAEC, Duhamel operation, and pull-through surgery before the age of 6 months were found to be independent factors associated with bowel dysfunction after pull-through surgery.

Keywords

Acknowledgement

The authors are very grateful to Dusit Viravaidya, Pornchai Achatsachat, Pattamon Sutthattarn, and all the staff in the Department of Pediatrics and Department of Surgery, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital for their excellent patient care.

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