Functional results of surgical treatment of Hirschsprung's disease in patients under 3 years of age

Abstract

Objective. To analyze the functional results of surgical treatment of Hirschsprung's disease in patients under 3 years of age.

Materials and methods. Over a 10-year period, 119 patients under 3 years of age with Hirschsprung's disease were operated on at the Republican Scientific and Practical Center for Pediatric Surgery. Two main groups of patients were identified: group 1 – patients underwent Duhamel (Duhamel – Martin) surgery; group 2 – patients underwent transanal endorectal bowel reduction. The study of remote functional results was carried out by subjective methods (complaints, anamnesis, questionnaires) and objective (examination, irrigoscopy, instrumental methods) ones.

Results. In the period of 1 – 3 years after the operation, the functional results of surgical interventions were monitored, with the primary assessment being the regularity of bowel movements and the absence of constipation (81.0 %), the presence of fecal smearing (14.2 %) or episodes of fecal incontinence (1.8 %). Irrigoscopy allowed us to assess the motor-evacuation function of the intestine. The study was conducted on 52 patients after radical correction of Hirschsprung's disease, who had complaints of constipation or fecal smearing. Preservation of a uniform diameter of the colon without its expansion along the entire length during irrigoscopy, the presence of haustration, and timely emptying of the colon were considered as a favorable radiographic picture, and were detected in 71.2 % of cases. Changes in the intestine, characterized by its dilation, smoothing of haustration, and slow emptying were regarded as unfavorable, and were detected in 28.8 %. The quality of life of patients under 3 years of age, according to the questionnaire, was practically not affected.

Conclusion. Analysis of the results of treatment of Hirschsprung's disease with various methods of surgical treatment showed that complete adaptation of patients when following rehabilitation recommendations occurs 1 – 3 years after radical surgical treatment with satisfactory functional results in 87.4 % of cases, including patients with complications.