EFFECTS OF ANAL INVASIVE TREATMENT AND INCONTINENCE ON MENTAL-HEALTH AND PSYCHOSOCIAL FUNCTIONING OF ADOLESCENTS WITH HIRSCHSPRUNGS-DISEASEAND LOW ANORECTAL ANOMALIES
Th. Diseth et al., EFFECTS OF ANAL INVASIVE TREATMENT AND INCONTINENCE ON MENTAL-HEALTH AND PSYCHOSOCIAL FUNCTIONING OF ADOLESCENTS WITH HIRSCHSPRUNGS-DISEASEAND LOW ANORECTAL ANOMALIES, Journal of pediatric surgery, 33(3), 1998, pp. 468-475
Background/Purpose: Recent studies of adolescents with Hirschsprung's
disease (HD) and low anorectal anomalies (LARA) showed persistent impa
irment of fecal control in both groups, but very different mental and
psychosocial outcome,. Methods: To explore possible reasons for these
differences, 19 adolescents with HD (aged 10 to 20 years; median, 16)
operated on by the Duhamel technique were compared with 17 adolescents
with LARA (aged 12 to 20 years; median, 15), The 36 adolescents were
assessed for treatment procedures, bowel function, and mental and psyc
hosocial outcome by data collected from medical records, physical exam
ination, semistructured interview, and standardized questionnaires, Th
e parents of 30 adolescents were also interviewed and completed questi
onnaires.Results: Duration of anal invasive treatment procedure and cu
rrent bowel function were associated with mental and psychosocial outc
ome, The treatment variable, duration of anal dilation, was the most s
ignificant predictor of the adolescents's mental health (R-2 = .41, P
< .01), whereas chronic family difficulties and parental warmth togeth
er with the current bowel function variables, fecal and flatus contine
nce function, best explained the variance in psychosocial outcome (R-2
= .77, P < .0001). Thus, the differences in treatment procedures and
continence function between the HD and LARA groups may partially expla
in differences in mental and psychosocial outcome. Conclusions: These
findings suggest that anal dilatation and continence dysfunction may h
ave negative impact on mental health and psychosocial functioning. Ind
ications for and ways of performing the procedure of dilation, and the
treatment of persistent incontinence problems, are questioned. Copyri
ght (C) 1998 by W.B. Saunders Company.