Nursing Intervention for Outpatient Rehabilitation in Pediatric Patients with Hirschsprung Disease after Colectomy

Abstract

Objective The present study was designed to evaluate the effectiveness of a nursing intervention program for outpatient rehabilitation of children with Hirschsprung-associated enterocolitis (HAEC) after radical colectomy for Hirschsprung disease (HD).

Background Postoperative outcomes severely affect the quality of life in pediatric HD patients after operation. The improvement in defecation function is regarded as one of the most useful parameters to evaluate the quality of life in HD patients after radical intestinal resection. A close attention should also be paid to the patients' ability of social adaptation.

Methods This prospective, randomized control trial enrolled 85 pediatric patients with HAEC after colectomy. They were randomly divided into the control and intervention groups. All the patients were followed up for 6 to 12 months after initial HAEC treatment.

Results The intervention group had a lower enterocolitis recurrence rate than the control group, with a better ability to control defecation and their parents had better rehabilitation nursing knowledge (p < 0.05). The degree of parents' satisfaction regarding the outcome was significantly better in the intervention group than that in the control group (p < 0.05).

Conclusion A systemic rehabilitation nursing program could decrease enterocolitis recurrence, improve the recovery of anorectal functions, and enhance the quality of life in the pediatric patients after radical colectomy.

Keywords

Hirschsprung disease - enterocolitis - rehabilitation nursing intervention - quality of life - colectomy

• References

• 1 Georgeson KE, Fuenfer MM, Hardin WD. Primary laparoscopic pull-through for Hirschsprung's disease in infants and children. J Pediatr Surg 1995; 30 (7) 1017-1021 , discussion 1021–1022
• 2 Wang G, Sun XY, Wei MF, Weng YZ. Heart-shaped anastomosis for Hirschsprung's disease: Operative technique and long-term follow-up. World J Gastroenterol 2005; 11 (2) 296-298
• 3 Gasparovic I, Kovac D, Persic M, Slavic I, Nikolic H, Jonjic N. Ganglia/nerve fibers ratio correlates with the need for surgery in patients diagnosed with Hirschsprung's disease allied disorder (HAD). Fetal Pediatr Pathol 2011; 30 (6) 405-413
• 4 Wu X, Feng J, Wei M , et al. Patterns of postoperative enterocolitis in children with Hirschsprung's disease combined with hypoganglionosis. J Pediatr Surg 2009; 44 (7) 1401-1404
• 5 Pastor AC, Osman F, Teitelbaum DH, Caty MG, Langer JC. Development of a standardized definition for Hirschsprung's-associated enterocolitis: a Delphi analysis. J Pediatr Surg 2009; 44 (1) 251-256
• 6 Wildhaber BE, Teitelbaum DH, Coran AG. Total colonic Hirschsprung's disease: a 28-year experience. J Pediatr Surg 2005; 40 (1) 203-206 , discussion 206–207
• 7 Gunnarsdóttir A, Sandblom G, Arnbjörnsson E, Larsson LT. Quality of life in adults operated on for Hirschsprung disease in childhood. J Pediatr Gastroenterol Nutr 2010; 51 (2) 160-166
• 8 Ieiri S, Nakatsuji T, Akiyoshi J , et al. Long-term outcomes and the quality of life of Hirschsprung disease in adolescents who have reached 18 years or older—a 47-year single-institute experience. J Pediatr Surg 2010; 45 (12) 2398-2402
• 9 Núñez R, Torres A, Agulla E, Moreno C, Marín D, Santamaría JI. Rectal irrigation and bowel decontamination for the prevention of postoperative enterocolitis in Hirschsprung's disease [in Spanish]. Cir Pediatr 2007; 20 (2) 96-100
• 10 Raval MV, Hall NJ, Pierro A, Moss RL. Evidence-based prevention and surgical treatment of necrotizing enterocolitis-a review of randomized controlled trials. Semin Pediatr Surg 2013; 22 (2) 117-121
• 11 El-Sawaf M, Siddiqui S, Mahmoud M, Drongowski R, Teitelbaum DH. Probiotic prophylaxis after pullthrough for Hirschsprung disease to reduce incidence of enterocolitis: a prospective, randomized, double-blind, placebo-controlled, multicenter trial. J Pediatr Surg 2013; 48 (1) 111-117
• 12 Borody TJ, Campbell J. Fecal microbiota transplantation: techniques, applications, and issues. Gastroenterol Clin North Am 2012; 41 (4) 781-803
• 13 Chumpitazi BP, Nurko S. Defecation disorders in children after surgery for Hirschsprung disease. J Pediatr Gastroenterol Nutr 2011; 53 (1) 75-79
• 14 Kassam Z, Hundal R, Marshall JK, Lee CH. Fecal transplant via retention enema for refractory or recurrent Clostridium difficile infection. Arch Intern Med 2012; 172 (2) 191-193
• 15 Zhu T, Feng J, Zhang W , et al. Subtotal colectomy with a single-incision laparoscopic surgery technique in children with long-segment Hirschsprung disease and allied disorders. Pediatr Surg Int 2013; 29 (2) 197-201
• 16 Grano C, Aminoff D, Lucidi F, Violani C. Long-term disease-specific quality of life in children and adolescent patients with ARM. J Pediatr Surg 2012; 47 (7) 1317-1322
• 17 Di Palma JA, Herrera JL. The role of effective clinician-patient communication in the management of irritable bowel syndrome and chronic constipation. J Clin Gastroenterol 2012; 46 (9) 748-751
• 18 Sheng Q, Lv Z, Xiao X. Re-operation for Hirschsprung's disease: experience in 24 patients from China. Pediatr Surg Int 2012; 28 (5) 501-506