Comparison of the quality of life of children with congenital megacolon (Hirschsprung’s disease) post transanal endorectal pull-through with other children's surgical cases in the 5-7-years age group at Moewardi Hospital Surakarta


  • Riza S. Agrensa Department of Surgery, Sebelas Maret University, Surakarta, Indonesia
  • Suwardi Division of Pediatric Surgery, Department of Surgery, Moewardi Hospital, Surakarta, Indonesia
  • Hari W. Nugroho Division of Growth Development, Department of Pediatric, Moewardi Hospital, Surakarta, Indonesia
  • Ida B. Budhi S. A. Division of Digestive Surgery, Department of Surgery Medical Faculty Sebelas Maret University, Moewardi Hospital, Surakarta, Indonesia



Hirschsprung's disease, Congenital megacolon, Transanal endorectal pullthrough, Quality of life


Background: Congenital megacolon (Hirschsprung's disease) is caused by intestinal innervation abnormalities, due to failure of neuroblast migration from the proximal to the distal intestine so there is no nerve innervation in the distal intestine and causes functional ileus and hypertrophy and excessive intestinal distension. The classic triad of clinical features in neonates is late meconium expulsion, namely more than the first 24 hours, green vomiting, and an enlarged stomach. Management of congenital megacolon is divided into two, namely non-surgical treatment to overcome complications that may occur and to improve the general condition until definitive surgery and surgical treatment namely transabdominal approach (TAB), consisting of Swenson, Duhamel, Rehbein, and Soave, and transanal endorectal pull-through (TEPT). The advantages of TEPT include better cosmetic effects and shorter hospital stays. Quality of life (QoL) is a subjective perception of a person's well-being regarding levels in his life, which includes physical, social, and psychological conditions.

Methods: This research is observational analytical research with a cross-sectional approach conducted at RSUD Dr. Moewardi Surakarta during August - September 2022.

Results: Patients with congenital megacolon (Hirschsprung disease) after TEPT have a worse QoL than patients without congenital megacolon (p value <0.05). All components of the pediatrics quality of life questionnaire (PedsQLTM) are influenced by the patient's condition (p value <0.05).

Conclusions: The poor quality of life should increase awareness of the importance of immediate treatment. Difficulty defecating, diarrhea, and abdominal pain can reduce the patient's QoL after TEPT. Family dynamics and support must be prioritized to improve the QoL.


Hirschsprung Disease: Background, Pathophysiology, Epidemiology. Available at: Accessed on 19 October 2023.

Kartono D. Penyakit Hirschsprung Neonatus. In: Kumpulan Kuliah Ilmu Bedah. Bagian Ilmu Bedah Fakultas Kedokteran Universitas Indonesia / RS dr. Cipto Mangunkusumo. 2003;141-3.

Mckeown SJ, Stamp L, Hao MM, Young HM. Hirschsprung disease: a developmental disorder of the enteric nervous system. Wiley Interdiscip Rev Dev Biol. 2013;2(1):113-29.

Leonidas JC, Singh SP, Slovis TL. Congenital Anomalies of The Gastrointestinal Tract. Caffey’s Pediatric Diagnostic Imaging. 10th Edition. Elsevier - Mosby. 2004;148-53.

Swenson O. Hirschsprung’s Disease: A Review. Pediatrics. 2002;109(5):914-8.

Wyllie R. Megakolon Aganglionik Bawaan (PenyakitHirschsprung). Bemann, Kliegman, Arvin. In: Ilmu Kesehatan Anak, Nelson. 15th edition. 2000;1316-9.

Hamami AH, Pieter J, Riwanto I, Tjambolang T, Ahmadsyah I. Penyakit Hirschsprung. In: Sjamsuhidajat R, Jong WD, editors. Buku Ajar Ilmu Bedah. 2nd edition. EGC. 2004;670-1.

Kohno M, Ikawa H, Konuma K. Comparison of the postoperative bowel function between transanal endorectal pull-through and transabdominal pull-through for Hirschsprung’s disease: a study of the feces excretion function using an RI-defecogram. Pediatr Surg Int. 2009;25(11):949-54.

De La Torre L, Langer JC. Transanal endorectal pull-through for Hirschsprung disease: technique, controversies, pearls, pitfalls, and an organized approach to the management of postoperative obstructive symptoms. Semin Pediatr Surg. 2010;19(2):96-106.

Yan BL, Bi LW, Yang QY, Wu XS, Cui HL. Transanal endorectal pull-through procedure versus transabdominal surgery for Hirschsprung disease. Medicine. 2019;98(32):e16777.

Mathias AL, Tannuri ACA, Ferreira MAE, Santos MM, Tannuri U. Validation of questionnaires to assess quality of life related to fecal incontinence in children with anorectal malformations and Hirschsprung’s disease. Revista Paulista de Pediatria. 2016;34(1):99.

Loganathan AK, Mathew AS, Kurian JJ. Assessment of Quality of Life and Functional Outcomes of Operated Cases of Hirschsprung Disease in a Developing Country. Pediatr Gastroenterol Hepatol Nutr. 2021;24(2):145.

Varni JW, Burwinkle TM, Seid M. The PedsQL as a pediatric patient-reported outcome: reliability and validity of the PedsQL Measurement Model in 25,000 children. Expert Rev Pharmacoecon Outcomes Res. 2005;5(6):705-19.

Tannuri ACA, Ferreira MAE, Mathias AL, Tannuri U. Long-term results of the Duhamel technique are superior to those of the transanal pullthrough: A study of fecal continence and quality of life. J Pediatr Surg. 2017;52(3):449-53.

Feng X, Lacher M, Quitmann J, Witt S, Witvliet MJ, Mayer S. Health-Related Quality of Life and Psychosocial Morbidity in Anorectal Malformation and Hirschsprung’s Disease. Eur J Pediatr Surg. 2020;30(3):279-86.

Dai Y, Deng Y, Lin Y, Ouyang R, Li L. Long-term outcomes and quality of life of patients with Hirschsprung disease: A systematic review and meta-analysis. BMC Gastroenterol. 2020;20(1):1-13.

Espeso L, Coutable A, Flaum V, Rebeuh J, Lavrand F, Podevin G, et al. Persistent Soiling Affects Quality of Life in Children With Hirschsprung’s Disease. J Pediatr Gastroenterol Nutr. 2020;70(2):238-42.

Svetanoff WJ, Kapalu CL, Lopez JJ, Fraser JA, Briggs KB, Rentea RM. Psychosocial factors affecting quality of life in patients with anorectal malformation and Hirschsprung disease-a qualitative systematic review. J Pediatr Surg. 2022;57(3):387-93.

Allin BSR, Opondo C, Bradnock T, et al. Impact of rectal dissection technique on primary-school-age outcomes for a British and Irish cohort of children with Hirschsprung disease. J Pediatr Surg. 2022;57(12):902-911. doi:10.1016/J.JPEDSURG.2022.05.006

Ataullaevich AK, Akilov KA, Mamajanov US, Halimzhonovich MB, Olimovich TS. Quality of life in children with Hirschsprung’s disease after surgery de la Torre-Ortega Pediatric surgery of the center for professional development of medical workers. World Bull Public Health. 2022;12:73-7.

Mille E, Dariel A, Louis-Borrione C, Merrot T, Loundou A, Tosello B, Gire C. Quality of life and neuropsychological development at school age in Hirschsprung's disease. J Pediatr Surg. 2020;55(8):1481-7.






Original Research Articles