Early functional outcomes of the Swenson ileoanal pull-through for total colonic Hirschsprung disease at a high-volume referral center.

INTRODUCTION

There is no consensus for the optimal surgical approach for total colonic Hirschsprung disease (TCHD) and few studies report functional outcomes for the ileoanal Swenson pull-through (IAPT).

METHODS

A single-center retrospective review identified patients with TCHD who underwent IAPT between 1/2020 and12/2023. Complications and functional outcomes were reviewed descriptively.

RESULTS

25 patients (64 % male) underwent IAPT at a median age of 1.6 years (range 0.6, - 15.6; IQR, 0.9-7.0) with a median follow-up of 16 months (range, 1-39; IQR, 3-26). Four patients required readmission within 30 days and 8 within 1 year. One patient required readmission for Hirschsprung's associated enterocolitis (HAEC) within 30 days and Four within 1 year. One patient had an unplanned return to the operating room. At 1 month, 48 % (12/25) reported ≥14 stools/day and 20 % (5/25) had 1-7 stools/day. Among patients with at least 1 year follow up only 14 % (2/14) reported ≥14 stools/day and 57 % (8/14) reported 1-7 stools/day. At 1 month, 48 % (12/25) reported severe or active perianal excoriation; by 1 year, no patients reported severe or active perianal excoriation. One patient underwent elective ileostomy creation due to a high stooling frequency. Overall, 64 % (16/25) underwent anal botulinum toxin injection for withholding, 16 % (4/25) required treatment for small intestinal bacterial overgrowth, and 12 % (3/25) required treatment for proctalgia fugax.

CONCLUSION

Patients with TCHD who undergo IAPT have low perioperative complication rates, and most achieve manageable stooling patterns without severe or active perianal excoriations by at least 1 year after IAPT. Approximately two-thirds of patients may require botulinum toxin treatment for non-relaxing sphincters.

IRB APPROVAL: STUDY00000962.

STUDY TYPE: Single institution.

LEVEL OF EVIDENCE: IV.