1. Nitin Sharma, S Agarwala, V. Bhatnagar
LONG TERM FUNCTIONAL OUTCOME AND QUALITY OF LIFE IN OPERATED CASES OF HIRSCHPRUNG’S DISEASE
Nitin Sharma, S Agarwala, V. Bhatnagar
Department of Pediatric Surgery
All India Institute of Medical Sciences New Delhi,India

2. Aims and Objectives LONG TERM OUTCOMES Quality of life
Continence status

3. Study design- Cross sectional study
Materials and Methods
Study design- Cross sectional study
Mean age at surgery- 2 years 9 months(1-5 years)
Mean age at evaluation-7 years 9 months(2-17 years)
n=33
Hirschsprung's disease (Long + short segment )=28
Total Colonic Aganglionosis=5

4. Patient Selection ≥3 years of age at evaluation
INCLUSION CRITERIA
EXCLUSION CRITERIA
≥3 years of age at evaluation
at least 2 years Post repair
Completed all the procedures
Pull through done at AIIMS
Refusal of consent for participation
Redo pull through cases
Associated conditions like Down’s syndrome, mental retardation, etc.

5. Continence status: Krickenbeck Classification (2005)
VOLUNTARY BOWEL MOVEMENTS
PRESENT
Feeling of urge
+ Capacity to verbalize
+Hold the bowel movement
ABSENT
SOILING S0
No soiling S1
Occasionally (once or twice per week)/ S2
Soiling everyday S3
Constant soiling
CONSTIPATION C0
Absent C1
Managed by changes in diet C2
Requires laxatives C3
Resistant to diet and laxatives

6. Result of continence status29

7. Results: Soiling Incidence: 12/33(36%)
All had minimal soiling (S1)
Correlation of soiling with various parameters
Age (p=0.790)
Sex (p=0.284)
Diagnosis (p=0.328)
Type of procedure(p=0.268)
Bowel Pulled down(p=0.118)

8. Results: Constipation
Incidence: 4/33(12%)
All had minimal constipation (C1)
Correlation of soiling with various parameters
Age (p=0.346)
Sex (p=1.000)
Diagnosis (p=1.000)
Type of procedure(p=0.392)
Bowel Pulled down(p=0.146)

9. Quality of life questionnaire
Social Habit
Regular habit 3
Irregular habit 2
Different habit with problem 1
No social activity
School Attendance
Full time
Part time
Never
Daily activity
As peers
Less than pears
Restricted
Relation to peers
Good 2
Limited 1
No relation
Feelings
Normal 3
Feeling different
Less appreciated
Afraid and depressed
Total 12

10. Grading of quality of life
QOL
Score
Patients
GOOD
8-12
32(97%)
FAIR
5-7
1(3%)
POOR
0-4

11. QOL DIAGNOSIS TYPE OF PROCEDURE SEX AGE
MEAN=11
MEAN=11
QOL
MEAN=11
MEAN=11
MEAN=11
SEX
AGE
PART OF THE BOWEL PULLED THROUGH

12. SOCIAL HABIT SOILING CONSTIPATION P=0.046 P=0.571 DIAGNOSIS P=1.00
TYPE OF PROCEDURE
P=0.690
P=0.006
P=1.00
AGE
SEX
PART OF THE BOWEL PULLED THROUGH

13. SCHOOL ATTENDENCE SOILING CONSTIPATION P=0.045 P=0.297 DIAGNOSIS
TYPE OF PROCEDURE
P=0.327
P=0.656
P=1.00
AGE
SEX
PART OF THE BOWEL PULLED THROUGH

14. RELATION TO PEERS SOILING CONSTIPATION P=0.523 P=1.00 DIAGNOSIS P=1.00
TYPE OF PROCEDURE
P=0.432
P=0.536
P=1.00
AGE
SEX
PART OF THE BOWEL PULLED THROUGH

15. Conclusion
Continence and voluntary bowel movements are usually present.
Few patients have constipation and soiling.
Most of the patients have a good quality of life
Soiling strongly affects quality of life (social habits and school attendance).

16. THANKS