Pediatric Surgery International

, Volume 34, Issue 1, pp 47–53 | Cite as

Are all patients with short segment Hirschsprung’s disease equal? A retrospective multicenter study

  • Patrick Ho Yu Chung
  • Kenneth Kak Yuen Wong
  • Paul Kwong Hang Tam
  • Michael Wai Yip Leung
  • Nicholas Sih Yin Chao
  • Kelvin Kam Wing Liu
  • Edwin Kin Wai Chan
  • Yuk Him Tam
  • Kim Hung Lee
Original Article
  • 114 Downloads

Abstract

Background/purpose

Short segment Hirschsprung’s disease (HSCR) carries a better prognosis than long segment disease, but the definition of short is controversial. The objective of this study is to determine anatomically the extent of disease involvement that would be associated with a better functional outcome.

Methods

This is a retrospective multicenter (n = 3) study with patients (≥ 3 years) who had transanal pullthrough operation done for aganglionosis limited to the recto-sigmoid colon were reviewed. The extent of disease involvement and bowel resection was retrieved by reviewing the operative records as well as histopathological reports of the resected specimens. Clinical assessment was performed according to the criteria of a seven-itemed bowel function score (BFS) (maximum score = 20). Manometric assessment was performed with anorectal manometry.

Results

The study period started from 2003 to 45 patients were studied with median age at assessment = 52.0 months and operation = 3.0 months. The disease involvement was categorized into upper sigmoid-descending colon (DC) (n = 8), sigmoid colon (SC) (n = 12), upper rectum (UR) (n = 14) and lower rectum (LR) (n = 11) according to the level of normal biopsy result. There was no significant difference in the age of assessment between the four groups. The median BFSs in the DC, SC, UR and LR were 13, 15, 17 and 17, respectively (p = 0.01). Nine patients from the DC and SC groups reported soiling for more than twice per week. Sub-group analysis comparing patients with and without the entire sigmoid colon resected revealed worse functional outcomes in terms of the incidence of soiling (40.7 vs 22.2%, p = 0.05) and the BFS (14 vs 18, p = 0.04) in the former group. Anorectal manometry did not reveal any significant difference between the four groups, but a higher proportion of patients in the UR and LR groups appeared to have a normal sphincter resting pressure (DC vs SC vs UR vs LR = 62.5 vs 75.0 vs 85.7 vs 80.0%, p = 0.10).

Conclusion

Patients with short segment HSCR are not equal at all. HSCR patients with aganglionosis limited to the rectum without the need of removing the entire sigmoid colon have a better bowel control and overall functional score. Less bowel loss and colonic dissection maybe the underlying reasons. Although future studies with a larger sample size and a longer follow-up period are required to validate the results of this study, it has provided a new insight to the current understanding of short segment disease in HSCR.

Keywords

Hirschsprung’s disease Aganglionosis Anorectal manometry Transanal 

Notes

Acknowledgements

This study was supported in part by the Theme-based Research Scheme (TRS T12C-714/14-R) from the Hong Kong Research Grants Council to P.T.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest with respect to this manuscript.

Funding

Theme-based research scheme from the Hong Kong Research Grants Council (TRS Ref#: T12C-714/14-R) to Paul Tam.

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Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  • Patrick Ho Yu Chung
    • 1
  • Kenneth Kak Yuen Wong
    • 1
  • Paul Kwong Hang Tam
    • 1
  • Michael Wai Yip Leung
    • 2
  • Nicholas Sih Yin Chao
    • 3
  • Kelvin Kam Wing Liu
    • 3
  • Edwin Kin Wai Chan
    • 4
  • Yuk Him Tam
    • 4
  • Kim Hung Lee
    • 4
  1. 1.Division of Pediatric Surgery, Department of Surgery, Queen Mary Hospital, Li Ka Shing Faculty of MedicineThe University of Hong KongHong KongChina
  2. 2.Division of Pediatric Surgery, Department of SurgeryQueen Elizabeth HospitalHong KongChina
  3. 3.Division of Pediatric Surgery, Department of SurgeryUnited Christian HospitalHong KongChina
  4. 4.Division of Pediatric Surgery and Pediatric Urology, Department of Surgery, Prince of Wales HospitalThe Chinese University of Hong KongHong KongChina

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