Permanent stoma in the outcome of treatment of Hirschsprung's disease in children - analysis of results and literature review

Introduction. Permanent stoma (PS) is one of the most unfavorable outcomes of Hirschsprung's disease (HD) treatment, permanently depriving the patient of the opportunity to realize the physiological needs for defecation. The article analyzes own and literature data on the causes of PS. The purpose of the study. To analyze the results of treatment of patients with HD who underwent a treatment method in the form of a permanent intestinal stoma. Materials and methods. The study included 367 patients with HD who received treatment during the period from 2016 to 2024 was carried out. Most of the children underwent radical surgery in different clinics using the Soave-Georgeson method. Among them, PS occurred in 8 cases. The reason for the permanent stoma was long-term recurrent complications: abscesses (n=7), fistulas of the perineum (n=5), fecal incontinence (n=6) and rectal stenosis (n=2). 3 patients had syndromic forms of HD, total agangliosis (TA) was diagnosed in 5 cases. Results. The analysis confirmed that permanent stoma formation in Hirschsprung’s disease (HD) is a necessary measure driven by severe complications such as anastomotic failure, recurrent abscesses, fistulas, and fecal incontinence. Key risk factors for permanent stoma (PS) include total aganglionosis (TA) and delayed specialized surgical intervention. The statistically significant association between TA and PS (p=0.002) and between delayed treatment and stoma risk (p=0.023) underscores the importance of early diagnosis and timely radical surgery. Patients with syndromic forms of HD require particular attention due to their increased risk of adverse outcomes. Conclusion. The study highlights the need for individualized surgical approaches, improved anastomotic techniques, and dynamic postoperative monitoring to minimize PS risk. Reducing the frequency of stoma formation may be achievable through optimized timing of surgical interventions, especially in total forms of HD, and proactive prevention of postoperative complications.

Hirschsprung's disease, permanent stoma, children

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