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

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Bjornland , K , Pakarinen , M P , Stenstrom , P , Stensrud , K J , Neuvonen , M , Granström , A L , Graneli , C , Pripp , A H , Arnbjörnsson , E , Emblem , R , Wester , T , Rintala , R J & Nordic Pediat Surgery Study Consor 2017 , ' A Nordic multicenter survey of long-term bowel function after transanal endorectal pull-through in 200 patients with rectosigmoid Hirschsprung disease ' , Journal of Pediatric Surgery , vol. 52 , no. 9 , pp. 1458-1464 . https://doi.org/10.1016/j.jpedsurg.2017.01.001

Title: A Nordic multicenter survey of long-term bowel function after transanal endorectal pull-through in 200 patients with rectosigmoid Hirschsprung disease
Author: Bjornland, Kristin; Pakarinen, Mikko P.; Stenstrom, Pernilla; Stensrud, Kjetil J.; Neuvonen, Malla; Granström, Anna L.; Graneli, Christina; Pripp, Are H.; Arnbjörnsson, Einar; Emblem, Ragnhild; Wester, Tomas; Rintala, Risto J.; Nordic Pediat Surgery Study Consor
Contributor: University of Helsinki, Children's Hospital
University of Helsinki, Clinicum
Date: 2017-09
Language: eng
Number of pages: 7
Belongs to series: Journal of Pediatric Surgery
ISSN: 0022-3468
URI: http://hdl.handle.net/10138/299387
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 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. (C) 2017 Elsevier Inc. All rights reserved.
Subject: Hirschsprung
Long-term bowel function
Pull-through
Fecal incontinence
Enterocolitis
ANORECTAL-MALFORMATIONS
FECAL CONTINENCE
FOLLOW-UP
PREVENTION
3123 Gynaecology and paediatrics
3126 Surgery, anesthesiology, intensive care, radiology
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