Bowel function assessment and affecting factors in patients operated for Hirschsprung’s disease and Anorectal malformations in a resource-limited area: A five-year review

Introduction: Hirschsprung disease (HSD) and anorectal malformation (ARM) are among the common congenital anomalies encountered in the practice of pediatric surgery. Children who have undergone definitive repair for these disorders may suffer from various complications. This study aims to assess bowel function and the associated factors in patients from a low-income country, as this matter has remained largely unreported in this setting. Methods A retrospective review of children who underwent definitive surgical repair for HSD and ARM, and who were 3 years or older, was included in the study. Rintala's bowel function score was used to assess the outcome. The chi-square test was used to assess the association between several variables and bowel function score. All associations with a P value of < 0.05 were considered significant. Results A total of 132 children were operated on in the study period, and 100 of them were above 3 years and beyond 6 months after the surgery. Among these, the charts of 81 patients were available for analysis. HSD patients accounted for 58(71.6%) of the study participants with a mean age of 4.2 +/- 1.4 years and male to female ratio of 2.4:1. Patients for ARM constituted for 23(28.4%) of the study population with mean age of 3.9 +/- 1.4 years and male to female ratio of 0.9:1. Among children who have undergone pull through, the Rintala bowel function score was good in 37(64%), fair in 16(27.6%) and poor in 5(8.6%) of patients while it was good in 37(74%), fair in 3(13%) and poor in 3(13%) of ARM patients. Late presentation with chronic constipation (P = 0.045, OR = 1.474) was found to be significantly associated with poor bowel function score in patients with HSD, while the type of ARM (P = 0.000, OR = 2.545) and late age at presentation (P = 0.024, OR = 1.247) were found to be the significant variables for ARM patients. Conclusion A significant number of children who have undergone definitive repair for HSD and ARM have fair to poor bowel function scores. Late presentation of children with these pathologies is found to be a significant contributor to the poor outcome in low-income countries.