| Objective Congenital aganglionic megacolon (Hirschsprung' s disease, HD) is one of common gastrointestinal tract malformation. Generally, postoperative results in the surgical management of HD appear to be satisfactory. Despite this reported good over all outcome, many studies show a higher than anticipated incidence of problems after surgery for HD. Patients with HD have a frequency of persistent fecal dysfunction and psychosocial problems. One difficulty in assessing results is that the majority of long-term follow-up studies have concentrated only on the functional outcome. Although this is important, little emphasis is being placed on developmental outcome and quality of life in the child following successful treatment for HD. The aim of this study was to examine the overall long-term status of patients who have undergone surgery for HD. This study also evaluated the developmental and psychosocial adjustment of these patients to determine the overall impact of HD surgery on the child.Methods 119 patients with HD were assessed for bowel function, mental health and psychosocial function by adequate clinical data, semistuctured interview, and standardized questionnaires. 46 patients (mean age 7. 92 years) with Hirschsprung' s disease were interviewed and completed questionnaires. This sample appeared to be representative of the whole in terms of demographic features such as ethnic group, sex, length of aganglionic segment, timing of presentation and surgery performed. In the 46 patients, the median age of operation was 2.76 years; the median time at follow-up was 5.63 years. Aganglionosis extended to the rectosigmoid region in 24, proximal to splenic flexure in 12, only to distal rectum in 8, and total colonic aganglionosis in 2. Treatment included modified Duhamel procedure in 21, modified Swenson in 16, Ikeda in 5 Boley in 3 sphincterotomy-myectomy in 1. Enterostomy was performed in 9 children. The adolescents were compared with 45 controls.Results (l)No differences were found among patients' bowel function on the type of treatment, the age of treatment and the time at follow-up. But bowel function were significantly different among the type of pathology. (2)Micturition disturbance and sexual dysfunction were not significantly related to the type of surgery treatment. (3)23. 91% of patients with HD had significant psychosocial dysfunction than their healthy peers (6. 67%). Among boys from 6 to 11 years old, 42. 86% of patients with HDhad significant molimen problem than their healthy peers(9.52%). (4)Psychosocial problems were significantly different among the types of pathology.Conclusions The anorectal function in children with HD are not always as good as surgeons may perceive, especially poor fecal continence in TCA and long-segment aganglionosis. Long-term follow-up is important. In the meantime, HD and HD surgical correction have significant impacts on psychosocial problems in children. Optimal treatment of patients with Hirschsprung' s disease requires somatic and psychological care from their parents, teachers and doctors. |
