title: [Efficacy and safety of the Jinling procedure in the treatment of adult Hirschsprung disease].
abstract: OBJECTIVE
  To investigate the safety, efficacy and long-term outcomes of Jinling procedure in the treatment of adult Hirschsprung disease.
  
  
  METHODS
  Clinical and follow-up data of 125 patients with adult Hirschsprung disease undergoing Jinling procedure at the Department of General Surgery between January 2000 and January 2013 were summarized. All the patients were diagnosed by CT, barium enema, anorectal pressure detection and pathology examination. Abdominal symptoms, gastrointestinal quality of life index(GIQLI, the lower score, the worse quality of life), Wexner constipation score (higher score indicated worse symptom), defecography (evaluation included rectocele, mucosal prolapse, intramucosal intussusception, perineal prolapse) and other operative complications were compared before and after operation.
  
  
  RESULTS
  Among 125 patients, 69 were male and 56 were female with median age of (41.2±15.5) (18 to 75) years. The follow-up rates were 94.4%(118/125), 92.0%(115/125), 89.6%(112/125) and 88.0%(110/125) at postoperative months 1, 3, 6, and 12. Incidences of abdominal distension and abdominal pain were 100% and 82.4%(103/125) before operation, and were 7.3%(8/110) and 20.9%(23/110) at 12 months after surgery. Wexner score was significantly lower at postoperative months 1(8.7±2.9), 3 (7.2±2.8), 6(6.7±2.2) and 12(6.3±1.7) than that before operation (21.4±7.2) (P<0.01). GIQLI score was 51.6±11.9 before operation, though it decreased at 1 month (47.3±5.5)(P<0.05) after surgery, but increased significantly at postoperative months 3, 6, 12(68.9±8.0, 96.5±8.2, 103.2±8.6)(P<0.01). Abnormal rate of defecography was 70.4%(81/115), 48.2%(54/112) and 27.3%(30/110) at postoperative months 3, 6, 12, which was significantly lower than 91.2%(114/125) before operation (P<0.01). Morbidity of postoperative complication was 29.6%(37/125), including 5 cases of surgical site infection (4.0%), 2 of anastomotic bleeding (1.6%), 8 of anastomotic leakage (6.4%, one died of severe abdominal infection), 4 of urinary retention (3.2%), 3 of recurrent constipation (2.4%, without megacolon relapse), 11 of bowel obstruction (8.8%), 2 of anastomotic stricture(1.6%) and 2 of refractory staphylococcus aureus enteritis (1.6%, diagnosed by stool smear and culture, and both died finally).
  
  
  CONCLUSIONS
  Jinling procedure is a safe and effective surgical procedure for adult Hirschsprung's disease.
authors.forename: Bin
authors.initials: B
authors.lastname: Quan
authors.forename: Qiyi
authors.initials: Q
authors.lastname: Chen
authors.affiliation: Research Institute of General Surgery, Jinling Hospital, Nanjing University School of Medicine, Nanjing 210002, China. jiangjun6987@163.com.
authors.forename: Jun
authors.initials: J
authors.lastname: Jiang
authors.forename: Ling
authors.initials: L
authors.lastname: Ni
authors.forename: Rongrong
authors.initials: R
authors.lastname: Tang
authors.forename: Yu
authors.initials: Y
authors.lastname: Huang
authors.forename: Yifang
authors.initials: Y
authors.lastname: Shi
authors.forename: Ning
authors.initials: N
authors.lastname: Li
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D003082:Colectomy; D003248:Constipation; D019841:Defecography; D013505:Digestive System Surgical Procedures; D005260:Female; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D007415:Intestinal Obstruction; D007443:Intussusception; D008297:Male; D008875:Middle Aged; D010502:Perineum; D011183:Postoperative Complications; D011184:Postoperative Period; D011788:Quality of Life; D020047:Rectocele; D013211:Staphylococcus aureus; D016896:Treatment Outcome; D055815:Young Adult