Post pull- through bowel function outcome and contributing factors in children; a cross-sectional study from low resource setting.

BACKGROUND

Pull-through, which is the standard surgical procedure for Hirschsprung's disease (HSD), can be associated with several short-term and long-term complications. This study aims to provide insight into the bowel function outcome of children who have undergone this procedure and are already beyond the toilet-training age as reports on such age groups are limited.

METHODS

This cross-sectional study evaluated the bowel function outcome of children who have undergone pull-through procedures over five years. All children were three years or older, and were at least in their sixth month and beyond after the procedure. Data management was done using the Statistical Package for Social Sciences (SPSS Version 26). Fischer's exact test was used to evaluate the association between independent variables and bowel function outcome, considering a confidence interval of 95% and a significant P value of < 0.05.

RESULTS

Of the 58 children, 41 (70.7%) were male, with a male-to-female ratio of 2.4:1. The median age was 3.9(IQR 3.3-4.9) years. Most of the children presented at post-neonatal age with chronic constipation 36 (63.8%). Stomas were constructed for all children initially without frozen section biopsy. Subsequently, soave pull-through was done for 56(96.6%) of the children. The median duration of follow-up after pull-through was 2.1(IQR 1.4-2.8) years. A quarter of the patients claimed to have normal bowel habits with full continence. Fecal soiling and constipation were reported in 33 (56.9%) and 26(44.8%) of patients, respectively. Both fecal soiling and constipation were experienced by 15(25.9%) of the children. Fischer's exact test revealed a significant association between colonic excision proximal to the splenic flexure and adverse bowel function outcome (P = 0.049).

CONCLUSION

A significant number of children experienced adverse bowel function outcome as only a quarter of them had normal bowel habits with full continence. Earlier diagnosis of HSD and the use of frozen section biopsy would have prevented long colonic resections leading to less adverse bowel function outcomes. A large multicenter study is recommended in the future to clearly define the predictive factors for post-pull-through adverse bowel function outcome.