Abstract
BackgroundTransanal endorectal pull-through (TEPT) is considered the most preferable treatment method for Hirschsprung disease (HSCR) since it is less invasive and has fewer morbidities than transabdominal pull-through. Here, functional outcomes in short-segment HSCR patients after TEPT were assessed and associated with the prognostic factors.MethodsKrickenbeck classification was used to assess the functional outcomes in patients with HSCR after TEPT surgery at our institution from 2012 to 2020.ResultsFifty patients were involved in this study. Voluntary bowel movement (VBM) was achieved in 82% of subjects. Nine (18%) subjects had soiling grade 1, while two (4%) and two (4%) patients suffered constipation that was manageable with diet and laxative agents, respectively. Patients who underwent TEPT at ≥ 4 years old tended to have soiling more than patients who underwent TEPT at < 4 years old (OR = 16.47 [95% CI 0.9–301.61]; p = 0.06), whereas patients with post-operative complications had 10.5-fold higher risk for constipation than patients without post-operative complications (p = 0.037; 95% CI 1.15–95.92). Multivariate analysis showed male sex was significantly associated with VBM (OR = 9.25 [95% CI 1.34–63.77]; p = 0.024), while post-operative complications were strongly correlated with constipation (OR = 10 [95% CI 1.09–91.44]; p = 0.04).ConclusionsThe functional outcomes of HSCR patients after TEPT in our institution are considered relatively good. Moreover, the VBM, soiling, and constipation risk after TEPT might be affected by sex, age at TEPT performed, and post-operative complications, respectively, while the age at TEPT performed might not be associated with functional outcomes. Further multicenter studies with a larger sample size are necessary to clarify and confirm our findings.
Highlights
Hirschsprung disease (HSCR) is a complex genetic anomaly, characterized by the absence of ganglion cells at the myenteric and submucosal plexus of the intestines, The goal of surgical management for HSCR is to remove the aganglionic colon and make an anastomosis above the dentate line to re-establish bowel continuityGunadi et al BMC Gastroenterol (2021) 21:85[5]
Baseline characteristics We examined 55 medical records of patients who were recruited consecutively and excluded 5 subjects due to incomplete medical records, i.e. no information on functional outcomes
Patients who underwent Transanal endorectal pull-through (TEPT) at ≥ 4 years old tended to have soiling more than patients who underwent TEPT at < 4 years old (OR = 16.47 [95% confidence interval (CI) 0.9–301.61]; p = 0.059) (Table 4)
Summary
Hirschsprung disease (HSCR) is a complex genetic anomaly, characterized by the absence of ganglion cells at the myenteric and submucosal plexus of the intestines, The goal of surgical management for HSCR is to remove the aganglionic colon and make an anastomosis above the dentate line to re-establish bowel continuityGunadi et al BMC Gastroenterol (2021) 21:85[5]. Transanal endorectal pull-through (TEPT) is considered the most preferable treatment method for patients with HSCR since it is less invasive and has fewer complications than transabdominal pull-through [5,6,7,8]. Several prognostic factors have been associated with the functional outcomes after TEPT and showed inconclusive findings, including sex and age at TEPT performed [9,10,11]. The aim of this study was to evaluate the functional outcomes of patients with HSCR after TEPT procedure and associate them with prognostic factors, such as sex, nutritional status, age at TEPT performed, and post-operative complications. Transanal endorectal pull-through (TEPT) is considered the most preferable treatment method for Hirschsprung disease (HSCR) since it is less invasive and has fewer morbidities than transabdominal pull-through. Functional outcomes in short-segment HSCR patients after TEPT were assessed and associated with the prognostic factors
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