A Nordic multicenter survey of long-term bowel function after transanal endorectal pull-through in 200 patients with rectosigmoid Hirschsprung disease

Abstract

A significant number of HD patients experience bowel problems many years after definite surgery. Fecal control was significantly better in older than younger HD patients, but some continued to have considerable bowel problems also as adults. A total transanal ERPT was associated with poorer outcome. Long-term follow-up of HD patients is warranted. Prognosis Study: Level II.

Long-term functional outcomes and quality of life in patients with Hirschsprung's disease

“…Following diagnosis, resection is usually performed to remove the aganglionic bowel and to restore continuity. Although many patients may attain normal bowel function following surgery, defaecation disorders, such as constipation or faecal incontinence, can persist.…”

Perioperative Complications of Transanal Pull-through Surgery for Hirschsprung's Disease

“…1,2 Today, pull-through is commonly performed during the neonatal period or early infancy soon after the diagnosis is confirmed. [3][4][5][6] Transanal pull-through includes variable surgical elements, which have undergone technical modifications during the last decades. Colonic mobilization and biopsies are often performed laparoscopically or through an umbilical mini-incision instead of conventional laparotomy, while other surgeons perform the entire operation and frozen section biopsies transanally.…”

“…1,2,[7][8][9][10][11][12] Although overall bowel functional outcomes are good in the majority of patients following transanal pull-through, a significant proportion of patients suffer from repeated episodes of enterocolitis and outlet obstruction as well as different degrees of fecal incontinence especially during early childhood, whereas constipation is a less frequent concern. 3,[5][6][7] Fortunately, with increasing age, fecal control gradually improves and reaches the level of normal population controls by young adulthood, while reasons for this agerelated improvement remains unclear. 5,6,13 Transanal pullthrough is associated with multiple potential complications, which may result in permanently impaired functional outcome, life-long morbidity, and significant social sequelae (►Table 1).…”

“…3,[5][6][7] Fortunately, with increasing age, fecal control gradually improves and reaches the level of normal population controls by young adulthood, while reasons for this agerelated improvement remains unclear. 5,6,13 Transanal pullthrough is associated with multiple potential complications, which may result in permanently impaired functional outcome, life-long morbidity, and significant social sequelae (►Table 1). Although some of the surgical complications can be successfully handled by repeat surgery, [14][15][16] they are best treated by efficient prevention with careful adherence to established surgical techniques and principles during the primary operation.…”

Centralized Pediatric Surgery in the Nordic Countries: A Role Model for Europe?

“…The Nordic countries share similar socioeconomic status, educational level, tax-funded healthcare systems, and level of pediatric surgical care, which not only provide comparable circumstances and challenges for centralization of pediatric surgical care, but also excellent basis for international multicenter research within these countries. 1,2 The population density is low in countries like Finland, Norway, and Sweden and is unevenly distributed over relatively large geographical areas. This may limit equal access to specialized pediatric surgical care leading to lengthy patient transportation distances between different parts of the countries and prolonged stay away from home for families during hospitalization.…”