title: A Nordic multicenter survey of long-term bowel function after transanal endorectal pull-through in 200 patients with rectosigmoid Hirschsprung disease.
abstract: OBJECTIVE
  Transanal endorectal pull-through (ERPT) is the most popular technique to treat Hirschsprung disease (HD). Still, there is limited knowledge on long-term bowel function. This cross-sectional, multicenter study assessed long-term bowel function in a large HD population and examined predictors of poor outcome.
  
  
  METHODS
  Patients older than four years or their parents filled out a validated questionnaire on bowel function. Clinical details were recorded retrospectively from medical records.
  
  
  RESULTS
  73/200 (37%) patients reported absolutely no impaired bowel function, meaning no constipation, fecal accidents, stoma, appendicostomy or need for enemas. Seven (4%) had a stoma, and 33 (17%) used antegrade or rectal colonic enemas. Most disarrangements of fecal control and constipation were significantly less common in older age group, but abnormal defecation frequency and social problems remained unchanged. Syndromic patients (n=31) experienced frequent fecal accidents (46%) more often than nonsyndromic (14%, P<0.001). Having a syndrome (adjusted OR 5.6, 95% CI 2.1-15, P=0.001) or a complete transanal ERPT (adjusted OR 2.4, 95% CI 1.1-5.7, P=0.038) was significantly associated with poor outcome defined as having a stoma, an appendicostomy, daily fecal accidents or need of regular rectal wash outs.
  
  
  CONCLUSIONS
  A significant number of HD patients experience bowel problems many years after definite surgery. Fecal control was significantly better in older than younger HD patients, but some continued to have considerable bowel problems also as adults. A total transanal ERPT was associated with poorer outcome. Long-term follow-up of HD patients is warranted. Prognosis Study: Level II.
authors.affiliation: Department of Paediatric Surgery, Oslo University Hospital-Rikshospitalet and University of Oslo, Oslo, Norway. Electronic address: Kristin.bjornland@medisin.uio.no.
authors.forename: Kristin
authors.initials: K
authors.lastname: Bjørnland
authors.affiliation: Department of Paediatric Surgery, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
authors.forename: Mikko P
authors.initials: MP
authors.lastname: Pakarinen
authors.affiliation: Department of Paediatric Surgery, Skåne University Hospital, Lund, Sweden.
authors.forename: Pernilla
authors.initials: P
authors.lastname: Stenstrøm
authors.affiliation: Department of Paediatric Surgery, Oslo University Hospital-Rikshospitalet and University of Oslo, Oslo, Norway.
authors.forename: Kjetil J
authors.initials: KJ
authors.lastname: Stensrud
authors.affiliation: Department of Paediatric Surgery, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
authors.forename: Malla
authors.initials: M
authors.lastname: Neuvonen
authors.affiliation: Department of Paediatric Surgery, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Anna L
authors.initials: AL
authors.lastname: Granström
authors.affiliation: Department of Paediatric Surgery, Skåne University Hospital, Lund, Sweden.
authors.forename: Christina
authors.initials: C
authors.lastname: Graneli
authors.affiliation: Department of Paediatric Surgery, Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway.
authors.forename: Are H
authors.initials: AH
authors.lastname: Pripp
authors.affiliation: Department of Paediatric Surgery, Skåne University Hospital, Lund, Sweden.
authors.forename: Einar
authors.initials: E
authors.lastname: Arnbjörnsson
authors.affiliation: Department of Paediatric Surgery, Oslo University Hospital-Rikshospitalet and University of Oslo, Oslo, Norway.
authors.forename: Ragnhild
authors.initials: R
authors.lastname: Emblem
authors.affiliation: Department of Paediatric Surgery, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Tomas
authors.initials: T
authors.lastname: Wester
authors.affiliation: Department of Paediatric Surgery, Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
authors.forename: Risto J
authors.initials: RJ
authors.lastname: Rintala
mesh_terms: D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000601:surgery*; D002648:Child; D003125:Colostomy; D003248:Constipation / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006627:Hirschsprung Disease / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D008297:Male; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D054047:Surgical Stomas; D016896:Treatment Outcome
keywords: Enterocolitis; Fecal incontinence; Hirschsprung; Long-term bowel function; Pull-through