BOWEL FUNCTION AND QUALITY-OF-LIFE IN ADULT PATIENTS WITH OPERATED HIRSCHSPRUNGS-DISEASE

Fecal continence and quality of Life were evaluated by a questionnaire in 100 patients (mean age 31 years, 88 males, 12 females) who had und ergone surgery for Hirschsprung's disease (HD) during the years 1950-1 975. The operative methods were Duhamel retrorectal pull-through or mo dified Duhamel operation in 71 patients, Swenson rectosigmoidectomy in 20, State-Rehbein anterior resection in 5, and Soave endorectal pull- through in 4. The postoperative follow-up period ranged from 15 to 39 years. Fecal continence was assessed by a score described by Holschnei der. Eighty-one healthy people with a similar age and sex distribution as the patients were used as controls. All controls and 91 patients h ad good fecal continence scores. Of the 9 patients who had fair scores , 3 were mentally retarded and 3 had postoperative anastomotic complic ations. If these 6 patients with an obvious cause for deficient anal f unction are excluded, there was no statistically significant differenc e in fecal continence between the patients and the controls. Equally g ood continence outcomes were achieved with all the operative methods. In adulthood, only 1 patient had chronic constipation. However, during childhood constipation was the main problem in 40 patients who develo ped a recurrent rectocolonic septum following the Duhamel operation. C onstipation subsided after recrushing of the septum. None of the patie nts had urinary incontinence. All the patients with a good continence outcome reported no limitations in their occupation, social life, or p hysical activities. We conclude that in adulthood the fecal continence and quality of life of most patients with operated HD do not differ f rom those of healthy adults.