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

Bjørnland, Kristin; Pakarinen, Mikko P; Stenstrøm, Pernilla LU ; Stensrud, Kjetil J; Neuvonen, Malla; Granström, Anna L; Graneli, Christina LU ; Pripp, Are H; Arnbjörnsson, Einar LU and Emblem, Ragnhild, et al. (2017) In Journal of Pediatric Surgery 52(9). p.1458-1464
Abstract

OBJECTIVE: Transanal endorectal pull-through (ERPT) is the most popular technique to treat Hirschsprung disease (HD). Still, there is limited knowledge on long-term bowel function. This cross-sectional, multicenter study assessed long-term bowel function in a large HD population and examined predictors of poor outcome.

METHODS: Patients older than four years or their parents filled out a validated questionnaire on bowel function. Clinical details were recorded retrospectively from medical records.

RESULTS: 73/200 (37%) patients reported absolutely no impaired bowel function, meaning no constipation, fecal accidents, stoma, appendicostomy or need for enemas. Seven (4%) had a stoma, and 33 (17%) used antegrade or rectal... (More)

OBJECTIVE: Transanal endorectal pull-through (ERPT) is the most popular technique to treat Hirschsprung disease (HD). Still, there is limited knowledge on long-term bowel function. This cross-sectional, multicenter study assessed long-term bowel function in a large HD population and examined predictors of poor outcome.

METHODS: Patients older than four years or their parents filled out a validated questionnaire on bowel function. Clinical details were recorded retrospectively from medical records.

RESULTS: 73/200 (37%) patients reported absolutely no impaired bowel function, meaning no constipation, fecal accidents, stoma, appendicostomy or need for enemas. Seven (4%) had a stoma, and 33 (17%) used antegrade or rectal colonic enemas. Most disarrangements of fecal control and constipation were significantly less common in older age group, but abnormal defecation frequency and social problems remained unchanged. Syndromic patients (n=31) experienced frequent fecal accidents (46%) more often than nonsyndromic (14%, P<0.001). Having a syndrome (adjusted OR 5.6, 95% CI 2.1-15, P=0.001) or a complete transanal ERPT (adjusted OR 2.4, 95% CI 1.1-5.7, P=0.038) was significantly associated with poor outcome defined as having a stoma, an appendicostomy, daily fecal accidents or need of regular rectal wash outs.

CONCLUSION: 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.

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Journal of Pediatric Surgery
volume
52
issue
9
pages
1458 - 1464
publisher
Elsevier
external identifiers
  • scopus:85009801659
  • wos:000410651900015
ISSN
1531-5037
DOI
10.1016/j.jpedsurg.2017.01.001
language
English
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yes
id
4b4b4c33-b612-48be-8d02-8603daec14a5
date added to LUP
2017-01-23 15:25:40
date last changed
2018-01-16 13:22:53
@article{4b4b4c33-b612-48be-8d02-8603daec14a5,
  abstract     = {<p>OBJECTIVE: Transanal endorectal pull-through (ERPT) is the most popular technique to treat Hirschsprung disease (HD). Still, there is limited knowledge on long-term bowel function. This cross-sectional, multicenter study assessed long-term bowel function in a large HD population and examined predictors of poor outcome.</p><p>METHODS: Patients older than four years or their parents filled out a validated questionnaire on bowel function. Clinical details were recorded retrospectively from medical records.</p><p>RESULTS: 73/200 (37%) patients reported absolutely no impaired bowel function, meaning no constipation, fecal accidents, stoma, appendicostomy or need for enemas. Seven (4%) had a stoma, and 33 (17%) used antegrade or rectal colonic enemas. Most disarrangements of fecal control and constipation were significantly less common in older age group, but abnormal defecation frequency and social problems remained unchanged. Syndromic patients (n=31) experienced frequent fecal accidents (46%) more often than nonsyndromic (14%, P&lt;0.001). Having a syndrome (adjusted OR 5.6, 95% CI 2.1-15, P=0.001) or a complete transanal ERPT (adjusted OR 2.4, 95% CI 1.1-5.7, P=0.038) was significantly associated with poor outcome defined as having a stoma, an appendicostomy, daily fecal accidents or need of regular rectal wash outs.</p><p>CONCLUSION: 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.</p>},
  author       = {Bjørnland, Kristin and Pakarinen, Mikko P and Stenstrøm, Pernilla and Stensrud, Kjetil J and Neuvonen, Malla and Granström, Anna L and Graneli, Christina and Pripp, Are H and Arnbjörnsson, Einar and Emblem, Ragnhild and Wester, Tomas and Rintala, Risto J and , },
  issn         = {1531-5037},
  language     = {eng},
  month        = {01},
  number       = {9},
  pages        = {1458--1464},
  publisher    = {Elsevier},
  series       = {Journal of Pediatric Surgery},
  title        = {A Nordic multicenter survey of long-term bowel function after transanal endorectal pull-through in 200 patients with rectosigmoid Hirschsprung disease},
  url          = {http://dx.doi.org/10.1016/j.jpedsurg.2017.01.001},
  volume       = {52},
  year         = {2017},
}