Marianne V Fosby1, Kjetil J Stensrud2, Kristin Bjørnland3. 1. Department of Pediatric Surgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway. Electronic address: martei@ous-hf.no. 2. Department of Pediatric Surgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway. 3. Department of Pediatric Surgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway; University of Oslo, Oslo, Norway.
Abstract
BACKGROUND: The reported functional outcome in patients operated with transanal endorectal pull-through (ERPT) for Hirschsprung disease (HD) varies greatly. Some studies suggest better functional outcome in older than in younger HD patients, but there are almost no longitudinal studies that have demonstrated such improvement. Therefore, we aimed to compare functional outcome in a cohort of HD patients over time to assess whether bowel function improves with increasing age. METHODS: Functional outcome in HD patients operated with ERPT from 1998 to 2007 was recorded by standardized interviews by an independent investigator during 2008-2011 and again in 2017/2018. Bowel function was assessed using the Krickenbeck questionnaire. Clinical data were collected prospectively. RESULTS: 50 of the original 62 patients responded for a second interview. Median age at the two interviews was 8,1 (3,4-16,6) and 15,4 (9,9-25) years respectively. There was no difference in the rate of soiling at first (52%) and second (52%) follow-up. Constipation was reported in 20% of the patients at first, and in 24% at second follow-up. Bowel management was used by 30% and 32% at first and second interview respectively. CONCLUSION: Soiling and constipation are common in HD patients several years after surgery, and no improvement of bowel function with increasing age could be demonstrated. LEVEL OF EVIDENCE: Level II.
BACKGROUND: The reported functional outcome in patients operated with transanal endorectal pull-through (ERPT) for Hirschsprung disease (HD) varies greatly. Some studies suggest better functional outcome in older than in younger HDpatients, but there are almost no longitudinal studies that have demonstrated such improvement. Therefore, we aimed to compare functional outcome in a cohort of HDpatients over time to assess whether bowel function improves with increasing age. METHODS: Functional outcome in HDpatients operated with ERPT from 1998 to 2007 was recorded by standardized interviews by an independent investigator during 2008-2011 and again in 2017/2018. Bowel function was assessed using the Krickenbeck questionnaire. Clinical data were collected prospectively. RESULTS: 50 of the original 62 patients responded for a second interview. Median age at the two interviews was 8,1 (3,4-16,6) and 15,4 (9,9-25) years respectively. There was no difference in the rate of soiling at first (52%) and second (52%) follow-up. Constipation was reported in 20% of the patients at first, and in 24% at second follow-up. Bowel management was used by 30% and 32% at first and second interview respectively. CONCLUSION: Soiling and constipation are common in HDpatients several years after surgery, and no improvement of bowel function with increasing age could be demonstrated. LEVEL OF EVIDENCE: Level II.