Clinical outcomes evaluation of congenital megacolon (Hirschsprung disease) short segment type after transanal endorectal pull through at Moewardi Hospital Surakarta

Erwin A. Ismail; Suwardi; Ida B. Budhi S. A.; Nunik Agustriani; Amru Sungkar; Setya A. Tusarawardaya

doi:10.18203/2349-2902.isj20233333

Authors

Erwin A. Ismail Department of Surgery, Sebelas Maret University, Surakarta, Indonesia
Suwardi Department of Surgery, Moewardi Hospital, Surakarta, Indonesia
Ida B. Budhi S. A. Department of Surgery, Medical Faculty Sebelas Maret University, Moewardi Hospital, Surakarta, Indonesia
Nunik Agustriani Department of Surgery, Moewardi Hospital, Surakarta, Indonesia
Amru Sungkar Department of Surgery, Medical Faculty Sebelas Maret University, Moewardi Hospital, Surakarta, Indonesia
Setya A. Tusarawardaya Department of Surgery, Medical Faculty Sebelas Maret University, Moewardi Hospital, Surakarta, Indonesia

DOI:

https://doi.org/10.18203/2349-2902.isj20233333

Keywords:

Hirschprung’s disease, Transanal endorectal pull-through, Clinical outcome

Abstract

Background: Congenital megacolon occurs in 1 in 5000 live births, with an estimated 1200 cases annually in Indonesia, predominantly affecting males. Mortality and morbidity in these patients can be reduced through improved diagnosis, neonatal care, surgical techniques, and enterocolitis management. The transanal endorectal pull through (TEPT) procedure, a minimally invasive surgery, is the common definitive treatment for congenital megacolon, performed even in neonates. However, TEPT can lead to post-operative anorectal dysfunction, necessitating assessment through fecal continence evaluation. The aims of this study is to understand of the clinical outcome congenital megacolon short segment type after TEPT procedure at Moewardi Hospital, Surakarta.

Methods: The study is a cross sectional descriptive analysis in patients with congenital megacolon short segment type who have received TEPT treatment at Moewardi Hospital Surakarta from 2010 until 2022.

Results: Among the patients, 18.9% exhibited normal anorectal function, 54.1% had good continence, 24.3% had moderate continence, and 2.7% experienced incontinence. Surgery age was mostly between 1 and 12 months (64.9%), with 62.2% achieving good continence. At the 1-5-year follow-up, 48.6% had good continence. Among primarily male patients (86.1%), 43.2% had good continence. Strong correlation (Pearson Chi-square score: 0.001) confirmed the relationship between age at the time of surgery and anorectal function outcomes.

Conclusions: TEPT yielded favorable anorectal function outcomes in short-segment congenital megacolon patients, with surgery age significantly impacting these outcomes. This study supports the hypothesis that surgery age influences anorectal function outcomes after TEPT at Moewardi Hospital, Surakarta.

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References

Wyllie R. Megakolon Aganglionik bawaan (Penyakit Hirschsprung). In: Nelson WE, Behrman RE, editor. Ilmu kesehatan Anak Nelson. 15th edition. Volume 2. Jakarta: EGC. 1999;1316-9.

Ali KAE. Transanal endorectal pull-through for Hirschsprung’s disease during the first month of life. Annal Pediatr Surg. 2010;6(2):81-8.

Rochadi. Hipoalbuminemia sebagai faktor prognostik enterokolitis pascabedah penderita megakolon kongenital (Hirschsprung’s disease). Jurnal Gizi Klinik Indonesia. 2013;9(3):111-6.

Stensrud KJ, Emblem R, Bjørnland K. Functional outcome after operation for Hirschsprung disease--transanal vs transabdominal approach. J Pediatr Surg. 2010;45(8):1640-4.

Surana R, Quinn FMJ, Puri P. Evaluation of risk factors in the development of enterocolitis complicating Hirschsprung's disease. Pediatr Surg Int. 1994;9:234-6.

Dutta HK. Clinical experience with a new modified transanal endorectal pull-through for Hirschsprung's disease. Pediatr Surg Int. 2010;26(7):747-51.

Setyadi A. Outcome. Pasien Hirschsprung Diesease di rumah Sakit dr. Zainal Abidin Banda Aceh Tahun 2011-2012. Skripsi. Banda Aceh : FK Unsyiah. 2013. Available at: http://103.107.101.35/baca/index.php? id=19994&page=1. Accessed on 12 July 2023.

Heikkinen M, Rintala R, Luukkonen P. Long-Term Anal Sphincter Performance After Surgery for Hirschsprung’s Disease. J Pediatric Surg. 1997;32(10):P1443-6.

Gunadi, Ivana G, Mursalin DA, Pitaka RT, Zain MW, Puspitarani DA, et al. Functional outcomes of patients with short-segment Hirschsprung disease after transanal endorectal pull-through. BMC Gastroenterol. 2021;21(1):85.

Isa MM, Syahputra DA, Hutagalung MB. Transanal endorectal pull-through in children as the treatment for Hirschsprung’SD in Aceh, Indonesia. Int Surg J. 2019;6(5):1443-6.

Zakaria, Ossama M, El Labban, Gouda M, Shams, Mohammed E. Fecal incontinence after single-stage Soave’s pull-through: abdominal versus transanal endorectal pull-through. Ann Pediatric Surg. 2012;8(1):5-8.

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.

Gandhi S, Makan A, Shenoy NS, Basu S, Tulsian A, Shah H. Outcome analysis of single-stage transanal endorectal pull through in selected patients with hirschsprung disease. Afr J Paediatr Surg. 2022;19(1):56-9.

Onishi S, Kaji T, Nakame K, Yamada K, Murakami M, Sugita K, et al. Optimal timing of definitive surgery for Hirschsprung's disease to achieve better long-term bowel function. Surg Today. 2022;52(1):92-7.