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Nitin Sharma, S Agarwala, V. Bhatnagar
LONG TERM FUNCTIONAL OUTCOME AND QUALITY OF LIFE IN OPERATED CASES OF HIRSCHPRUNG’S DISEASE Nitin Sharma, S Agarwala, V. Bhatnagar Department of Pediatric Surgery All India Institute of Medical Sciences New Delhi,India
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Aims and Objectives LONG TERM OUTCOMES Quality of life
Continence status
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Study design- Cross sectional study
Materials and Methods Study design- Cross sectional study Mean age at surgery- 2 years 9 months(1-5 years) Mean age at evaluation-7 years 9 months(2-17 years) n=33 Hirschsprung's disease (Long + short segment )=28 Total Colonic Aganglionosis=5
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Patient Selection ≥3 years of age at evaluation
INCLUSION CRITERIA EXCLUSION CRITERIA ≥3 years of age at evaluation at least 2 years Post repair Completed all the procedures Pull through done at AIIMS Refusal of consent for participation Redo pull through cases Associated conditions like Down’s syndrome, mental retardation, etc.
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Continence status: Krickenbeck Classification (2005)
VOLUNTARY BOWEL MOVEMENTS PRESENT Feeling of urge + Capacity to verbalize +Hold the bowel movement ABSENT SOILING S0 No soiling S1 Occasionally (once or twice per week)/ S2 Soiling everyday S3 Constant soiling CONSTIPATION C0 Absent C1 Managed by changes in diet C2 Requires laxatives C3 Resistant to diet and laxatives
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Result of continence status
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Results: Soiling Incidence: 12/33(36%)
All had minimal soiling (S1) Correlation of soiling with various parameters Age (p=0.790) Sex (p=0.284) Diagnosis (p=0.328) Type of procedure(p=0.268) Bowel Pulled down(p=0.118)
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Results: Constipation
Incidence: 4/33(12%) All had minimal constipation (C1) Correlation of soiling with various parameters Age (p=0.346) Sex (p=1.000) Diagnosis (p=1.000) Type of procedure(p=0.392) Bowel Pulled down(p=0.146)
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Quality of life questionnaire
Social Habit Regular habit 3 Irregular habit 2 Different habit with problem 1 No social activity School Attendance Full time Part time Never Daily activity As peers Less than pears Restricted Relation to peers Good 2 Limited 1 No relation Feelings Normal 3 Feeling different Less appreciated Afraid and depressed Total 12
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Grading of quality of life
QOL Score Patients GOOD 8-12 32(97%) FAIR 5-7 1(3%) POOR 0-4
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QOL DIAGNOSIS TYPE OF PROCEDURE SEX AGE
MEAN=11 MEAN=11 QOL MEAN=11 MEAN=11 MEAN=11 SEX AGE PART OF THE BOWEL PULLED THROUGH
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SOCIAL HABIT SOILING CONSTIPATION P=0.046 P=0.571 DIAGNOSIS P=1.00
TYPE OF PROCEDURE P=0.690 P=0.006 P=1.00 AGE SEX PART OF THE BOWEL PULLED THROUGH
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SCHOOL ATTENDENCE SOILING CONSTIPATION P=0.045 P=0.297 DIAGNOSIS
TYPE OF PROCEDURE P=0.327 P=0.656 P=1.00 AGE SEX PART OF THE BOWEL PULLED THROUGH
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RELATION TO PEERS SOILING CONSTIPATION P=0.523 P=1.00 DIAGNOSIS P=1.00
TYPE OF PROCEDURE P=0.432 P=0.536 P=1.00 AGE SEX PART OF THE BOWEL PULLED THROUGH
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Conclusion Continence and voluntary bowel movements are usually present. Few patients have constipation and soiling. Most of the patients have a good quality of life Soiling strongly affects quality of life (social habits and school attendance).
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THANKS
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