Impact of rectal dissection technique on primary-school-age outcomes for a British and Irish cohort of children with Hirschsprung disease

Allin, BSR; Opondo, C; Bradnock, T; Kenny, SE; Kurinczuk, JJ; Walker, G; Knight, M

Journal article

Impact of rectal dissection technique on primary-school-age outcomes for a British and Irish cohort of children with Hirschsprung disease

Abstract:: Background
This prospective cohort study compared primary-school-aged outcomes between children with Hirschsprung disease (HD) following Soave, Duhamel or Swenson procedures.
Methods
Children with histologically proven HD were identified in British/Irish paediatric surgical centers (01/10/2010-30/09/2012). Parent/clinician outcomes were collected when children were 5–8 years old and combined with management/early outcomes data. Propensity score/covariate adjusted multiple-event-Cox and multivariable logistic regression analyses were used.
Results
277 (91%) of 305 children underwent a pull-through (53% Soave, 37% Duhamel, 9% Swenson). Based upon 259 children (94%) with complete operative data, unplanned reoperation rates (95% CI) per-person year of follow-up were 0.11 (0.08–0.13), 0.34 (0.29–0.40) and 1.06 (0.86–1.31) in the Soave/Duhamel/Swenson groups respectively. Adjusted Hazard Ratios for unplanned reoperation compared with the Soave were 1.50 (95% CI 0.66-3.44, p = 0.335) and 7.57 (95% CI 3.39-16.93, p < 0.001) for the Duhamel/Swenson respectively. Of 217 post-pull-through children with 5–8 year follow-up, 62%, 55%, and 62% in Soave/Duhamel/Swenson groups reported faecal incontinence. In comparison to Soave, Duhamel was associated with lower risk of faecal incontinence (aOR 0.34,95%CI 0.13-0.89,p = 0.028). Of 191 children without a stoma, 42%, 59% and 30% in Soave/Duhamel/Swenson groups required assistance to maintain bowel movements; compared to Soave, the Duhamel group were more likely to require assistance (aOR 2.61,95% CI 1.03–6.60,p = 0.043).
Conclusions
Compared with Soave, Swenson was associated with increased risk of unplanned reoperation, whilst Duhamel was associated with reduced risk of faecal incontinence, but increased risk of constipation at 5–8 years of age. The risk profiles described can be used to inform consent discussions between surgeons and parents.

Publication status:: Published

Peer review status:: Peer reviewed

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APA Style

Allin, B. S. R., Opondo, C., Bradnock, T., Kenny, S. E., Kurinczuk, J. J., Walker, G., & Knight, M. (2022). Impact of rectal dissection technique on primary-school-age outcomes for a British and Irish cohort of children with Hirschsprung disease. Journal of Pediatric Surgery, 57(12), P902–911.

MLA Style

Allin, B. SR, et al. “Impact of Rectal Dissection Technique on Primary-School-Age Outcomes for a British and Irish Cohort of Children with Hirschsprung Disease.” Journal of Pediatric Surgery, vol. 57, no. 12, Elsevier, 2022, pp. P902–911.

Chicago Style

Allin, BSR, C Opondo, T Bradnock, SE Kenny, JJ Kurinczuk, G Walker, and M Knight. 2022. “Impact of Rectal Dissection Technique on Primary-School-Age Outcomes for a British and Irish Cohort of Children with Hirschsprung Disease.” Journal of Pediatric Surgery 57 (12): P902–911.
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