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Comparison of outcomes of two methods of surgery (J-pouch and ileorectal anastomosis) in children with total colonic aganglionosis, Hirschsprung?s disease

Ashjaei Bahar, Nahvi Hedayatollal

Background and objectives: Hirschsprung disease is commonly diagnosed in early childhood by aganglion areas in rectal biopsy. Diagnosed infants usually undergo a primary procedure and the definitive surgical treatment is usually performed several months later. Different surgical methods have been proposed for its treatment, but the detailed outcome of each method should be further investigated. Thus, we aimed to retrospectively assess the outcomes between two surgical methods for consistency of intestinal continuity, including J-Pouch and ileorectal anastomosis, in total colectomy procedure, in patients with total colon aganglionosis in our center.

Materials and methods: In this study, we retrospectively assessed all children undergoing total colectomy after primary ileostomy in Children’s Medical Center Hospital, from 1994 to 2016. In this center, intestinal continuity was provided by J-pouch procedure from 1994 to 2003, and by ileorectal anastomosis from 2003 to 2016. In the second method, 0.2 mg/kg loperamide was started after the first surgery (ileostomy) and was increased until the skin around ileostomy was just like the intact skin around colostomy with no significant inflammation. Data including demographic characteristics, need for re-ileostomy, duration of hospitalization, duration of NPO after surgery, and amount of loperamide were recorded, and compared between the two groups. Postoperative short-term complications were also recorded and compared. During the three-year follow-up period, all patients were assessed for soiling and fecal continence.

Results: Among 37 patients undergoing total colectomy due to total colon aganglionosis, 48.6% underwent J-pouch procedure (group 1) and 51.4% ileorectal anastomosis (group 2). In general, 54.1% were female and 45.9% were male. Mean hospitalization time was significantly lower in the second group (P=0.000). Mean NPO time was 7.06 ± 2.55 days in the first group and 3.63 ± 0.49 days in the second group (P=0.000). The rate of enterocolitis and mean surgical duration were significantly higher in the first group (P=0.001, and 0.000). None of the patients reported any fecal incontinence or constipation after surgery in both groups. Other postoperative complications had no statistically difference regarding leak, peri-anal inflammation, number of defecations, soiling, anastomosis stricture, need for re-ileostomy, pelvic abscess, peritonitis, and adhesion band.

Conclusion: As the results of the present study indicated, the surgical method of ileorectal anastomosis has significant advantages to J-pouch procedure, including less hospitalization time, surgical duration and NPO duration, no cases of enterocolitis, fecal incontinence or constipation, which, in general, indicates that ileorectal anastomosis is a better method than J-pouch.