Download PDF
Eur J Pediatr Surg 2021; 31(01): 040-048
DOI: 10.1055/s-0040-1715612
Original Article

Evaluation of Bowel Function, Urinary Tract Function, and Quality of Life after Transanal Endorectal Pull-Through Surgery for Hirschsprung's Disease

Cornelia Byström
1   Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden, Sweden
,
Sanna Östlund
1   Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden, Sweden
,
Nils Hoff
1   Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden, Sweden
,
Tomas Wester
1   Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden, Sweden
,
Anna Löf Granström
1   Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden, Sweden
› Author Affiliations
› Further Information
    Permissions and Reprints

Abstract

Introduction The objective of this study is to determine short-term complications and evaluate long-term bowel function, lower urinary tract symptoms, and quality of life (QoL) in patients treated for Hirschsprung's disease (HSCR) with transanal endorectal pull-though (TERPT) compared with healthy controls.

Materials and Methods This cross-sectional case–control study included 30 HSCR patients treated with TERPT in 2006 to 2014 at Karolinska University Hospital, and 30 healthy controls matched for age and gender. Data on short-term complications were compiled from medical records and classified according to Clavien-Dindo. Bowel function and QoL were evaluated with the validated questionnaires bowel function score and KIDSCREEN-52. Lower urinary tract symptoms were evaluated through an 8-item lower urinary tract symptoms (LUTS) questionnaire.

Results Six (20%) patients had a short-term postoperative complication according to Clavien-Dindo, with insufficient pain management being the most common complication. The median age at follow-up was 7 years (range = 4–11). Median bowel function score was significantly lower in HSCR patients than in controls, 14 versus 19 (p < 0.001). Twenty-one of the HSCR patients reported impaired bowel function compared with two of the controls (p < 0.001). The overall prevalence of LUTS was 11 (38%) in the HSCR patients compared with seven (23%) in the controls (p = 0.751). HSCR patients reported a slightly lower QoL in the KIDSCREEN domain “financial resources” compared with controls (p = 0.008).

Conclusion According to Clavien-Dindo, short-term postoperative complications occurred in 20% of the patients. Impaired bowel function persists throughout childhood for most HSCR patients. The prevalence of LUTS and QoL is not affected in HSCR patients compared with controls.

Keywords

Hirschsprung's disease - complications - bowel function - quality of life


Publication History

Received: 15 May 2020

Accepted: 14 July 2020

Article published online:
02 September 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Heanue TA, Pachnis V. Enteric nervous system development and Hirschsprung's disease: advances in genetic and stem cell studies. Nat Rev Neurosci 2007; 8 (06) 466-479
    CrossrefPubMedGoogle Scholar
  • 2 Dasgupta R, Langer JC. Hirschsprung disease. Curr Probl Surg 2004; 41 (12) 942-988
    CrossrefPubMedGoogle Scholar
  • 3 Bjørnland K, Pakarinen MP, Stenstrøm P. et al; Nordic Pediatric Surgery Study Consortium. A Nordic multicenter survey of long-term bowel function after transanal endorectal pull-through in 200 patients with rectosigmoid Hirschsprung disease. J Pediatr Surg 2017; 52 (09) 1458-1464
    CrossrefPubMedGoogle Scholar
  • 4 Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240 (02) 205-213
    Google Scholar
  • 5 Gunnarsdóttir A, Wester T. Modern treatment of Hirschsprung's disease. Scand J Surg 2011; 100 (04) 243-249
    CrossrefPubMedGoogle Scholar
  • 6 Jarvi K, Laitakari EM, Koivusalo A, Rintala RJ, Pakarinen MP. Bowel function and gastrointestinal quality of life among adults operated for Hirschsprung disease during childhood: a population-based study. Ann Surg 2010; 252 (06) 977-981
    CrossrefPubMedGoogle Scholar
  • 7 Neuvonen MI, Kyrklund K, Rintala RJ, Pakarinen MP. Bowel Function and Quality of Life After Transanal Endorectal Pull-through for Hirschsprung Disease: Controlled Outcomes up to Adulthood. Ann Surg 2017; 265 (03) 622-629
    CrossrefPubMedGoogle Scholar
  • 8 Granström AL, Husberg B, Nordenskjöld A, Svensson PJ, Wester T. Laparoscopic-assisted pull-through for Hirschsprung's disease, a prospective repeated evaluation of functional outcome. J Pediatr Surg 2013; 48 (12) 2536-2539
    CrossrefPubMedGoogle Scholar
  • 9 Diseth TH, Egeland T, Emblem R. Effects of anal invasive treatment and incontinence on mental health and psychosocial functioning of adolescents with Hirschsprung's disease and low anorectal anomalies. J Pediatr Surg 1998; 33 (03) 468-475
    CrossrefPubMedGoogle Scholar
  • 10 Boemers TM, Bax NM, van Gool JD. The effect of rectosigmoidectomy and Duhamel-type pull-through procedure on lower urinary tract function in children with Hirschsprung's disease. J Pediatr Surg 2001; 36 (03) 453-456
    CrossrefPubMedGoogle Scholar
  • 11 Moore SW, Albertyn R, Cywes S. Clinical outcome and long-term quality of life after surgical correction of Hirschsprung's disease. J Pediatr Surg 1996; 31 (11) 1496-1502
    CrossrefPubMedGoogle Scholar
  • 12 Hadidi A. Transanal endorectal pull-through for Hirschsprung's disease: experience with 68 patients. J Pediatr Surg 2003; 38 (09) 1337-1340
    CrossrefPubMedGoogle Scholar
  • 13 Neuvonen M, Kyrklund K, Taskinen S, Koivusalo A, Rintala RJ, Pakarinen MP. Lower urinary tract symptoms and sexual functions after endorectal pull-through for Hirschsprung disease: controlled long-term outcomes. J Pediatr Surg 2017; 52 (08) 1296-1301
    CrossrefPubMedGoogle Scholar
  • 14 Hoff N, Wester T, Granström AL. Classification of short-term complications after transanal endorectal pullthrough for Hirschsprung's disease using the Clavien-Dindo-grading system. Pediatr Surg Int 2019; 35 (11) 1239-1243
    CrossrefPubMedGoogle Scholar
  • 15 Stensrud KJ, Emblem R, Bjørnland K. Functional outcome after operation for Hirschsprung disease--transanal vs transabdominal approach. J Pediatr Surg 2010; 45 (08) 1640-1644
    CrossrefPubMedGoogle Scholar
  • 16 Granéli C, Dahlin E, Börjesson A, Arnbjörnsson E, Stenström P. Diagnosis, Symptoms, and Outcomes of Hirschsprung's Disease from the Perspective of Gender. Surg Res Pract 2017; 2017: 9274940
    PubMedGoogle Scholar
  • 17 De la Torre-Mondragón L, Ortega-Salgado JA. Transanal endorectal pull-through for Hirschsprung's disease. J Pediatr Surg 1998; 33 (08) 1283-1286
    CrossrefPubMedGoogle Scholar
  • 18 Wester T, Rintala RJ. Early outcome of transanal endorectal pull-through with a short muscle cuff during the neonatal period. J Pediatr Surg 2004; 39 (02) 157-160
    CrossrefPubMedGoogle Scholar
  • 19 Chen Y, Nah SA, Laksmi NK. et al. Transanal endorectal pull-through versus transabdominal approach for Hirschsprung's disease: a systematic review and meta-analysis. J Pediatr Surg 2013; 48 (03) 642-651
    CrossrefPubMedGoogle Scholar
  • 20 De La Torre L, Langer JC. Transanal endorectal pull-through for Hirschsprung disease: technique, controversies, pearls, pitfalls, and an organized approach to the management of postoperative obstructive symptoms. Semin Pediatr Surg 2010; 19 (02) 96-106
    CrossrefPubMedGoogle Scholar
  • 21 Kyrklund K, Koivusalo A, Rintala RJ, Pakarinen MP. Evaluation of bowel function and fecal continence in 594 Finnish individuals aged 4 to 26 years. Dis Colon Rectum 2012; 55: 671-676
    CrossrefPubMedGoogle Scholar
  • 22 Neuvonen MI, Kyrklund K, Lindahl HG, Koivusalo AI, Rintala RJ, Pakarinen MP. A population-based, complete follow-up of 146 consecutive patients after transanal mucosectomy for Hirschsprung disease. J Pediatr Surg 2015; 50 (10) 1653-1658
    CrossrefPubMedGoogle Scholar
  • 23 Linde JM, Nijman RJM, Trzpis M, Broens PMA. Prevalence of urinary incontinence and other lower urinary tract symptoms in children in the Netherlands. J Pediatr Urol 2019; 15 (02) 164.e1-164.e7
    CrossrefPubMedGoogle Scholar
  • 24 Kyrklund K, Taskinen S, Rintala RJ, Pakarinen MP. Lower urinary tract symptoms from childhood to adulthood: a population based study of 594 Finnish individuals 4 to 26 years old. J Urol 2012; 188 (02) 588-593
    CrossrefPubMedGoogle Scholar
  • 25 Hartman EE, Oort FJ, Aronson DC. et al. Explaining change in quality of life of children and adolescents with anorectal malformations or Hirschsprung disease. Pediatrics 2007; 119 (02) e374-e383
    CrossrefPubMedGoogle Scholar
  • 26 Ludman L, Spitz L, Tsuji H, Pierro A. Hirschsprung's disease: functional and psychological follow up comparing total colonic and rectosigmoid aganglionosis. Arch Dis Child 2002; 86 (05) 348-351
    CrossrefPubMedGoogle Scholar
  • 27 Compas BE, Jaser SS, Dunn MJ, Rodriguez EM. Coping with chronic illness in childhood and adolescence. Annu Rev Clin Psychol 2012; 8: 455-480
    CrossrefPubMedGoogle Scholar