The analysis of late postoperative complications in children treated for Hirschsprung disease in newborn and infant periods

Abstract

Introduction. Children who have undergone surgery under Hirschsprung disease (MH) come to the attention of territory physicians with postoperative enterocolitis, persistence of colostasis, obstruction and enuresis, which affects their psycho-emotional status. Aim of the study. Analysis of the rate of late postoperative complications in children treated for MH in dependence of the surgical-technical variant and the spreading of the non-ganglionic area. Material and methods. The study group included 84 newborns and infants hospitalized and treated in the NSPCPS "N. Gheorghiu" of PMSI IM and C for MH during the years 2007-2017. Depending on the anatomical and topographical characteristics of the affected colon segment, we defined the following locations in the non-ganglionic area: ultra-short (11.9%); rectosigmoidal (77.3%); long (6.0%) and ultra-long (4.8%). Radical treatment was provided by applying the both classical surgical methods like Duhamel method (16.6%), Swenson-Pellerin (34.5%), Soave-Leoniushkin (35.8%), total colectomy with cecrectal or ileorectal anastomosis (4, 8%), and minimally-invasive methods like trans-rectal endoanal descent (8.3%). The postoperative patient assessment scheme was provided for their supervision at 1, 3, 6, 9 and 12 months, then every 6 months until the recovery treatment was completed. The postoperative evaluation period ranged from 1.8 to 7.2 years, averaging 4.5 ± 2.7 years. Results. The criteria for evaluation of the remote postoperative results were the frequency of the stool, continence, urinary control, physical development (weight, height). Patients with the classical MH form corrected by Duhamel, Soave-Leoniushkin, Swenson-Pellerin, 80.4% had intestinal excretion once a day, the others (19.6%) once every 2 days or 2 times a day , without pathological clinical manifestations. Patients operated for the classical MH form had adequate control over the continence, regardless of the applied technique. Fecal excretion was recorded in 28.6% cases with a frequency of 1-3 times a day, particularly at patients with intestinal evacuation every other day. 96.6% of patients did not experience urinary dysfunction and clinical signs of neurogenic bladder. In 3.4% of children was found nocturnal enuresis corrected by physiotherapists and medical treatment. Physical development, in 89.8% of cases had a normal physical development appropriate to the age. The rest (10.2%) children experienced growth retardation and moderate weight deviations. Conclusions. Estimation of postoperative results indicates that the most vulnerable in this regard, were children operated for the ultra-long MH form, especially those who underwent colonectomy with resection of the ileocecal segment.