Content Analysis Identifies Nuanced Steps in Hirschsprung Disease (HD) Surgery Which Prevent Disabling Incontinence

Abstract

Abstract Purpose: Recently, poor function after Hirschprung Surgery has become more common. We hypothesized that accurate construction of the anorectal cuff and inclusion of certain technical in the procedure elements would correlate with improved long-term function.Methods: Anoscopy was performed on dysfunctional patients to measure the Anorectal cuff assigning a cuff score (CS) to assess the distance from the dentate line to the suture line. Using content analysis, a blinded observer abstracted nine originally described technical elements from operative reports. Function was evaluated from 1-3 years post-operative and classified as a) normal bowel function (NBF), b) constipation or c) incontinence. The outcomes were recorded as a function of each technical element found in the operative report.Results: CS in 12 incontinent and 8 constipated patients measured 8.75[0-22) and 60.77 (32-160) respectively. 92 operative reports were reviewed resulting in 58 patients being included. Overall, NBF was found in 36 (62%), 11 (20%) had constipation and 11 (20%) had incontinence. The presence of 5 elements in the operative reports corelated with NBF. When all 5 were documented, 23/26 (89%) reported NBF while if none were recorded only 3/19 (16 %) had NBF. Conclusion: Low CS (<22mm) is associated with incontinence while high CS (>32mm) is associated with constipation. Procedural components identified by content analysis are key to preventing incontinence.