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Functional outcomes in Hirschsprung disease patients after transabdominal Soave and Duhamel procedures.

ABSTRACT: Several pull-through procedures have been described for Hirschsprung disease (HSCR) with varying functional outcomes. The voluntary bowel movement (VBM) and the absence of soiling or constipation after pull-through remain the most important markers of good outcome. We aimed to compare the functional outcomes in HSCR patients following Soave and Duhamel procedures.Krickenbeck classification was utilized to determine VBM, soiling and constipation for patients who underwent Soave and Duhamel pull-through at Dr. Sardjito Hospital, Indonesia from 2013 to 2016.Fifty-three patients were ascertained (Soave: 23 males and 2 females vs. Duhamel: 22 males and 6 females, p =?0.26). Ninety-three and 88% patients had a VBM following Duhamel and Soave pull-through, respectively (p =?0.66). Constipation frequency was significantly higher in Soave than Duhamel groups (24% vs. 4%; p =?0.04) with OR of 8.5 (95% CI?=?1.0-76.7), whereas soiling rate was similar between Duhamel (21%) and Soave (8%) groups (p =?0.26). Furthermore, the risk of constipation was increased ~?21.7-fold in female patients after Soave procedure and was almost statistically significant (p =?0.05).The constipation rate is higher in patients who underwent Soave than Duhamel procedure, but the VBM and soiling frequencies are similar. The constipation risk following Soave pull-through might be increased by the female gender. Furthermore, a multicenter study with a larger sample of patients is necessary to clarify and confirm our findings.

SUBMITTER: Widyasari A

PROVIDER: S-EPMC5923197 | biostudies-other | 2018 Apr

REPOSITORIES: biostudies-other

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Functional outcomes in Hirschsprung disease patients after transabdominal Soave and Duhamel procedures.

Widyasari Amira A Pavitasari Winona Alda WA Dwihantoro Andi A Gunadi

BMC gastroenterology 20180427 1

<h4>Background</h4>Several pull-through procedures have been described for Hirschsprung disease (HSCR) with varying functional outcomes. The voluntary bowel movement (VBM) and the absence of soiling or constipation after pull-through remain the most important markers of good outcome. We aimed to compare the functional outcomes in HSCR patients following Soave and Duhamel procedures.<h4>Methods</h4>Krickenbeck classification was utilized to determine VBM, soiling and constipation for patients who ...[more]

PMID: 29703156

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Project description:BackgroundAdvances in surgical techniques and perioperative care have improved the short- and mid-term postoperative outcomes of patients with Hirschsprung disease (HD). However, the long-term outcomes of these patients (older than 10?years) have not been fully investigated. The aim of this systematic review is to clarify the prevalence of long-term outcomes and the quality of life of these patients.MethodsPubMed, AMED, Cochrane Library, CINAHL and PsycINFO databases were searched from inception to October 2018, following the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guideline. Original studies reporting the outcomes of patients older than ten years with HD were selected and reviewed. The overall prevalence of fecal incontinence, constipation, bowel function score, bladder dysfunction symptoms, and patients' quality of life were extracted from the included studies and pooled through the random-effects meta-analysis model. The heterogeneity and variation in the pooled estimations were evaluated by Cochrane's Q test and the I2 test. The sensitivity analysis was conducted by the sequential omission of individual studies. Publication bias was evaluated by Egger's linear regression test. The whole procedure was conducted with Stata (version 14).ResultsIn total, 3406 articles were identified from the literature search, among which twelve studies, including 625 patients, were included for analysis. The pooled prevalences of fecal incontinence, constipation, and bladder dysfunction symptoms and good to excellent bowel function scores were 0.20 (95% CI 0.13-0.28), 0.14 (95% CI 0.06-0.25), 0.07 (95% CI 0.04-0.12), and 0.95 (95% CI: 0.91-0.97), respectively; the pooled mean score of gastrointestinal-related quality of life was 118 (95% CI: 112.56-123.44).ConclusionsHD patients older than ten years old have an overall high prevalence of fecal incontinence and a low quality of life. Targeted and evidence-based follow-up procedures and transitional care are essential to meet these patients' long-term care needs. Prospective and multicenter research that focuses on the attributes and predictors of the long-term prognosis of patients with HD are necessary.

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Functional outcomes in Hirschsprung disease patients after transabdominal Soave and Duhamel procedures.

Publications

Functional outcomes in Hirschsprung disease patients after transabdominal Soave and Duhamel procedures.

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