COLOANAL ANASTOMOSIS FOR OPERATIVE MANAGEMENT OF HIRSCHSPRUNG'S DISEASE IN ADULTS
Eon Chul Han*1, Seung-Bum Ryoo2, Eun Kyung Choe3, Sang Hui Moon2, Kyu Joo Park2
1Surgery, Dongnam Institute of Radiological and Medical Sciences, Busan, Korea (the Republic of); 2Surgery, Seoul National University College of Medicine, Seoul, Korea (the Republic of); 3Seoul National University Hospital Gangnam Center, Seoul, Korea (the Republic of)
Background
Colorectal surgeons are usually unfamiliar with the standard procedures(e.g., Duhamel, Swenson, or Soave procedures) indicated for the treatment of Hirschsprung's disease (HD) in childhood. We sought to evaluate the outcome of coloanal anastomosis (CAA) performed in adult patients, presenting with obstructive symptoms of persistent HD.
Methods
We studied a total of 8 patients who underwent CAA for HD from 2009 to 2018. We analyzed the clinical characteristics and postoperative results. The degree of persistent fecal incontinence following the CAA was evaluated using the Wexner score, 1 year after the procedure. The patients themselves rated the functional outcome of the procedure as good, satisfactory, or poor.
Results
The median age of the patients was 37.5 years (range 21-31). Four patients were male. Corrective surgery had been performed for 7 patients in childhood. All the patients complained of constipation, requiring medication or enema for relief. The patients underwent CAA by hand-sewn (n=7) or double stapling(n=1) techniques. A diverting-loop ileostomy was constructed in each patient. There were no major postoperative complications. After a median follow-up of 15 months (range 8 - 29), 7 patients reported successful bowel evacuation(frequency: 5-10 times/day); the 8th patient had not undergone ileostomy closure. None of the patients had incontinence to solid stools or used pads. The patients did complain of incontinence to liquid feces (n=5) and gas (n=7). All patients graded the surgical outcome as satisfactory.
Conclusions
We conclude that CAA can be considered a feasible procedure for the management of HD in adult patients, including those who require a reoperation following surgery for HD.
Preoperative clinical characteristics of patients and results of reoperation
| Case no. | Age (year) | Age at first operation (year) | First operation name | Preoperative symptom | Symptom management before surgery | Method of coloanal anastomosis | Anastomosis of colon segment | Operation time (min) | Blood loss (ml) |
| 1 | 22 | 4 | Duhamel | Constipation | Laxative, enema | Hand sewing | T-colon | 148 | 300 |
| 2 | 23 | 2 | Duhamel | Constipation | Laxative, enema | Hand sewing | D-colon | 240 | 1650 |
| 3 | 29 | 1 | Duhamel | Perirectal abscess | Hartmann's operation | Hand sewing | D-colon | 128 | 100 |
| 4 | 31 | 2 | Duhamel | Constipation | Laxative, enema | Hand sewing | S-colon | 165 | 1600 |
| 5 | 26 | 2 | Soave | Constipation | Laxative, enema | Double stapling | T-colon | 188 | 350 |
| 6 | 29 | - | - | Constipation | Laxative, enema | Hand sewing | D-colon | 242 | 450 |
| 7 | 27 | 1 | Duhamel | Constipation | Laxative, enema | Hand sewing | D-colon | 167 | 500 |
| 8 | 21 | 19 | Subtotal colectomy | Constipation | Laxative, enema | Hand sewing | Ileum | 140 | 400 |
Wexner scores, long-term functional outcome and satisfaction of surgery after coloanal anastomosis
| Case no. | Solid | Liquid | Gas | Wears pad | Lifestyle alteration | Wexner scores | Satisfaction of surgery | Satisfaction of functional outcomes |
| 1 | 0 | 0 | 2 | 0 | 1 | 3 | Good | Good |
| 2 | 0 | 1 | 2 | 0 | 1 | 4 | Good | Good |
| 3 | 0 | 1 | 1 | 0 | 1 | 3 | Good | Good |
| 4 | 0 | 1 | 2 | 0 | 2 | 5 | Satisfaction | Good |
| 5 | 0 | 1 | 3 | 0 | 2 | 6 | Satisfaction | Satisfaction |
| 6 | 0 | 0 | 1 | 0 | 0 | 1 | Good | Good |
| 7 | 0 | 1 | 2 | 0 | 1 | 4 | Good | Good |
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