Research News
Preoperative HAEC, Surgical Technique, and Early Age of Surgery Impact Long-Term Bowel Function in Hirschsprung Patients
A recent study conducted at King Chulalongkorn Memorial Hospital in Bangkok, Thailand, investigated the long-term bowel dysfunction in children diagnosed with Hirschsprung disease (HD) after undergoing pull-through surgery. The findings highlight a significant prevalence of post-surgical complications and identify key factors associated with these issues.
The retrospective study reviewed medical records of 97 children diagnosed with HD between 2004 and 2022, with an average follow-up of 8.33 years.
Despite successful surgical correction, 64.95% of children experienced some form of bowel dysfunction. Hirschsprung-associated enterocolitis (HAEC) was the most frequent issue, affecting 46.39% of patients. Nonretentive incontinence was observed in 22.68% , constipation in 20.62% , and retentive incontinence in 15.46%.
Children who experienced HAEC before surgery were significantly more likely to develop HAEC after the pull-through operation (adjusted odds ratio [aOR] 18.31). The Duhamel surgical technique was significantly associated with postoperative constipation and retentive incontinence (aOR 62.15). Pull-through surgery performed before 6 months of age was significantly associated with nonretentive fecal incontinence after 4 years (aOR 8.83). This contradicts some previous studies but aligns with more recent findings from Poland and China.
The study emphasizes that while surgical treatment for Hirschsprung disease is generally favorable, long-term bowel dysfunctions remain a significant concern, impacting the quality of life for these patients. The identified risk factors provide crucial insights for improving long-term outcomes and guiding targeted management strategies, potentially including further motility studies to address functional problems. The findings also highlight the need for careful consideration of surgical approaches, especially in very young infants, due to the fragility of structures in the anal region.
Center of Excellence in Thai Pediatric Gastroenterology, Faculty of Medicine, Chulalongkorn University
Email: Palittiya.s@chula.ac.th