title: Does Functional Outcome Improve with Time Postsurgery for Hirschsprung Disease?
abstract: OBJECTIVE
  Constipation and incontinence are significant problems following pull-through surgery for Hirschsprung disease (HD). There is evidence that these problems improve with time. However, there is also evidence showing no improvements and furthermore, significant long-term data are lacking for the newer endorectal pull-through. We aim to determine if there is clinical evidence that show improvements in functional outcomes with time after an endorectal pull-through surgery for HD.
  
  
  METHODS
  We utilized the validated pediatric incontinence and constipation scoring system (PICSS) to score 51 consecutive children 3 months to 15 years posttransabdominal or transanal endorectal pull-through for HD. Cases of total colonic aganglionosis and Down syndrome were excluded. PICSS scores below the age-specific lower limit 95% confidence interval scores represent incomplete continence or constipation, respectively. We performed linear regression to analyze the relationship between PICSS scores and the follow-up duration and then compared the demographics of children with and without incomplete continence and constipation, respectively. Significance was set at p < 0.05.
  
  
  RESULTS
  The median age at PICSS interview was 71 months (range, 6-191 months). Incontinence scores obtained from 42 children older than 35 months showed a positive relationship with the follow-up duration (p = 0.03). Constipation scores obtained from 51 children were unrelated to follow-up duration (p = 0.486). When demographics were compared, the continent children had longer follow-up than those with incomplete continence (mean, 111.64 vs. 69.19 months; p = 0.051), however follow-up duration did not differ in the group of constipated children compared with the nonconstipated group (mean, 61.88 vs. 71.80 months; p = 0.321).
  
  
  CONCLUSIONS
  These findings suggest that after an endorectal pull-through, improved continence should be expected with time but constipation often continues to be an ongoing problem.
authors: Department of Paediatric Surgery, Children's University Hospital, Dublin, Ireland.
authors: Olugbenga Michael
authors: OM
authors: Aworanti
authors: Department of Paediatric Surgery, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.
authors: Dermot Thomas
authors: DT
authors: McDowell
authors: Department of Paediatric Surgery, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.
authors: Ian Michael
authors: IM
authors: Martin
authors: Department of Paediatric Surgery, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland.
authors: Feargal
authors: F
authors: Quinn
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003248:Constipation / Q000145:classification / Q000209:etiology / Q000628:therapy*; D005242:Fecal Incontinence / Q000145:classification / Q000628:therapy*; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007223:Infant; D011183:Postoperative Complications; D012720:Severity of Illness Index; D000067369:Transanal Endoscopic Microsurgery / Q000009:adverse effects; D016896:Treatment Outcome