Definitive surgery for Hirschsprung's disease under 4 months of age is associated with long-term complications: A cohort study

Aim
To correlate the age of definitive surgery to the long-term results and the prevalence of long-term complications after definitive operation of Hirschsprung’s disease.

Background
Long-term outcomes after definitive surgery of Hirschsprung’s disease seem to be satisfactory for the children, their parents and also for the surgeons. Children’s and parents’ perspectives of the overall outcome tend to differ from that of the surgeons, because they learn to cope with minor and major functional disturbances during the entire period of childhood. Because they adapt, their perspective of the overall outcome can be overestimated and are more satisfied than expected.

Materials and methods
Parents and patients were interviewed, asked to answer a standardized questionnaire, and examined. Patients’ hospital records were reviewed. Children were treated with the one-stage or multistage method. Duhamel-Martin and Transanal Endorectal Pull-Through (TEPT) techniques were used. Statistical analyses were performed using STATIS¬TICA 10.

Results
Thirty-one patients took part in the study. Duhamel-Martin technique was used on 12 children operated in stages. The one-stage TEPT method was used on 19 children. The most common complication was fecal incontinence, which occurred in 39% of the operated patients. Children who were operated on radically under 4 months of age had a higher prevalence of complications.

Conclusions
In children with Hirschsprung’s disease the definitive surgery should be considered no sooner than in the 4 months of age. Intestine ought to be exteriorized previously. Further studies in large cohorts are warranted in order to identify independent outcome-associated factors.