Robotic-assisted proctosigmoidectomy for Hirschsprung’s disease: A multicenter prospective study

Table 1 Scale for bowel function score

Evaluation on fecal continence	Score
Feels the urge to defecate
Always	3
Most of the time	2
Uncertain	1
Absent	0
Ability to hold back defecation
Always	3
Problems less than once a week	2
Weekly problems	1
No voluntary control	0
Frequency of defecation
Every other day-twice a day	2
More often	1
Less often	1
Soiling
Never	3
Staining less than once a week, no change of underwear required	2
Frequent staining/soiling, change of underwear required	1
Daily soiling, requires protective aids	0
Accidents
Never	3
Less than once a week	2
Weekly accidents, often requires protective aids	1
Daily, protective aids required day and night	0
Constipation
No constipation	3
Manageable with diet	2
Manageable with laxatives	1
Manageable with enemas	0
Social problems
No social problems	3
Sometimes (fouls odors)	2
Problems causing restrictions in social life	1
Major social/psychosocial problems	0

Table 2 Scale for postoperative fecal continence score

Evaluation on the POFC scores	0	1	2
Frequency of motions (/day)	≥ 6	3-5	1-2
Severity of staining/soiling	Soiling	Staining	None
Severity of perianal erosion	Often	Occasionally	Nil
Anal shape	Prolapse needing surgery	Mucosa visible	Normal
Requirement for medications	Antidiarrheals	Laxatives/enemas	Nil
Sensation of rectal fullness	Not at all1	Occasionally	Always2
Ability to distinguish flatus from stool	Not at all1	Occasionally	Always2

¹Full awareness or ability to distinguish less than once a week.

²Full awareness or ability to distinguish at least 4 out of 5 times (more than 80%).

POFC: postoperative fecal continence.

Table 3 Operative parameters of patients

Parameter	n (%) or mean ± SD/median (range)
Age at surgery (month)	9.50 (0.60-132.00)
≤ 1 mo	4 (2.56%)
≤ 3 mo	50 (32.05%)
≤ 1 yr	77 (49.36%)
≤ 3 yr	16 (10.26%)
> 3 yr	9 (5.77%)
Level of aganglionosis
Sigmoid colon	29 (32.95%)
Upper rectum	39 (44.32%)
Lower rectum	20 (22.73%)
Weight at surgery (kg)	9.09 ± 3.68
Operative time (min)	155.22 ± 16.77
Console time (min)	58.01 ± 7.71
Anal traction time (min)	45.28 ± 8.15
Transanal dissection time (min)	15.21 ± 2.67
Anastomosis time	30.01 ± 5.82
Estimated blood loss (mL)	5.01 ± 1.81
Pelvic dissection depth (cm)	4.50 ± 0.47
Length of the removed bowel (cm)	15.50 ± 5.23
Conversion	0 (0)
Intraoperative complications	0 (0)

Table 4 Postoperative outcomes of patients

Parameter	n (%) or mean ± SD /median (range)
Hospital stay (day)	7.25 ± 1.67
Follow-up time (month)	44.00 (6.00-78.00)
Outcomes within postoperative 30 d
Omental hernia	1 (0.64%)
Wound infections	2 (1.28%)
Lung infections	2 (1.28%)
Perianal dermatitis	13 (8.33%)
Uroschesis	0 (0)
Urinary incontinence	0 (0)
Anastomotic leakage	1 (0.64%)
Enterocolitis	6 (3.85%)
Cuff abscess	0 (0)
Post 30-d complications
Perianal dermatitis	0 (0)
Anastomotic strictures	2 (1.28%)
Sphincter spasm	0 (0)
Enterocolitis	16 (10.26%)
Soiling	7 (4.49%)
Staining	18 (11.54%)
Constipation	4 (2.56%)
Perianal dermatitis	1 (0.64%)

Table 5 Normal stool frequency and enterocolitis 1-6 years after surgery

	Younger group				Older group				P value	Total
	≤ 1 yr	1 < yr ≤ 2	2 < yr ≤ 4	4 < yr ≤ 6	≤ 1 yr	1 < yr ≤ 2	2 < yr ≤ 4	4 < yr ≤ 6		≤ 1 yr	1 < yr ≤ 2	2 < yr ≤ 4	4 < yr ≤ 6
	n = 54	n = 48	n = 38	n = 22	n = 102	n = 91	n = 74	n = 42		n = 156	n = 139	n = 112	n = 64
Normal stool frequency, n (%)	29 (53.70%)	34 (70.83%)	30 (78.95%)	19 (86.36%)	57 (55.88%)	67 (73.63%)	61 (82.43%)	38 (90.48%)	0.80, 0.73, 0.66, 0.94	86 (55.13%)	101 (72.66%)	91 (81.25%)	57 (89.06%)
Enterocolitis, n (%)	6 (11.11%)	5 (10.42%)	3 (7.89%)	1 (4.55%)	10 (9.80%)	7 (7.69%)	4 (5.41%)	2 (4.76%)	0.80, 0.82, 0.92, 1.00	16 (10.26%)	12 (8.63%)	7 (6.25%)	3 (4.69%)

Table 6 Bowel function scores and postoperative fecal continence scores among 88 patients aged 4 years or older

Parameter	Total (n = 88)
Bowel function score (Mean score ± SD)/n (%)
Feels the urge to defecate
Always	66 (75.00%)
Most of the time	19 (21.59%)
Uncertain	3 (3.41%)
Absent	0 (0)
Mean score ± SD	2.72 ± 0.52
Ability to hold back defecation
Always	63 (71.59%)
Problems less than once a week	17 (19.32%)
Weekly problems	8 (9.09%)
No voluntary control	0 (0)
Mean score ± SD	2.63 ± 0.65
Normal defecation frequency	55 (62.50%)
Mean score ± SD	1.63 ± 0.49
Fecal soiling
Never	32 (36.36%)
Staining < 1/wk	42 (47.73%)
Frequent soiling, change of underwear required	14 (15.91%)
Daily soiling, protective aids required	0 (0)
Mean score ± SD	2.23 ± 0.69
Fecal accidents
Never	63 (71.59%)
Less than once a week	18 (20.45%)
Weekly accidents, protective aids often required	6 (6.82%)
Daily, aids required day and night	1 (1.14%)
Mean score ± SD	2.63 ± 0.67
Constipation
No constipation	82 (93.18%)
Manageable with diet	0 (0)
Manageable with laxatives	4 (4.55%)
Manageable with enemas	2 (2.27%)
Mean score ± SD	2.84 ± 0.60
Social problems
No social problems	61 (69.32%)
Sometimes (fouls odors)	18 (20.45%)
Problems causing restrictions in social life	9 (10.23%)
Major social/psychosocial problems	0 (0)
Mean score ± SD	2.59 ± 0.67
Total score	17.32 ± 2.63
Good bowel function (total score ≥ 17)	66 (75.00%)
Moderate bowel function (12 ≤ total score ≤ 16)	14 (15.91%)
Poor bowel function (total score < 12)	8 (9.09%)
Postoperative fecal incontinence scores (Mean score ± SD)
Aged ≥ 4 years (n = 88)	10.95 ± 1.04
Aged ≥ 5 years (n = 60)	11.48 ± 0.72
Aged ≥ 6 years (n = 34)	11.94 ± 0.81

Table 7 Comparison of postoperative outcomes between the younger group and the older group

Parameter	Younger group (n = 54)	Older group (n = 102)	P value
Outcomes within postoperative 30 d, n (%)
Omental hernia	1 (1.85%)	0 (0)	0.35
Wound infections	1 (1.85%)	1 (0.98%)	1.00
Lung infections	2 (3.70%)	0 (0)	0.24
Perianal dermatitis	5 (9.26%)	8 (7.84%)	1.00
Uroschesis	0 (0)	0 (0)	-
Urinary incontinence	0 (0)	0 (0)	-
Anastomotic leakage	1 (1.85%)	0 (0)	0.35
Enterocolitis	4 (7.41%)	2 (1.96%)	0.21
Cuff abscess	0 (0)	0 (0)	-
Post-30-d complications, n (%)
Perianal dermatitis	0 (0)	0 (0)	-
Anastomotic strictures	1 (1.85%)	1 (0.98%)	1.00
Sphincter spasm	0 (0)	0 (0)	-
Enterocolitis	6 (11.11%)	10 (9.80%)	0.80
Soiling	3 (5.56%)	4 (3.92%)	0.95
Staining	7 (12.96%)	11 (10.78%)	0.69
Constipation	1 (1.85%)	3 (2.94%)	1.00
Perianal dermatitis	1 (1.85%)	0 (0)	0.35

Table 8 Bowel function scores and postoperative fecal incontinence scores among patients aged 4 years or older between the younger group and the older group

Parameters	Younger group (n = 26)	Older group (n = 62)	P value
Bowel function scores (Mean score ± SD)
Feels the urge to defecate	2.65 ± 0.63	2.74 ± 0.48	0.68
Ability to hold back defecation	2.58 ± 0.70	2.65 ± 0.63	0.71
Normal defecation frequency	1.69 ± 0.47	1.60 ± 0.49	0.40
Fecal soiling	2.19 ± 0.63	2.24 ± 0.72	0.67
Fecal accidents	2.58 ± 0.81	2.65 ± 0.60	0.98
Constipation	2.81 ± 0.69	2.85 ± 0.57	0.82
Social problems	2.62 ± 0.64	2.58 ± 0.69	0.93
Total bowel function score	17.19 ± 2.87	17.37 ± 2.54	0.90
Postoperative fecal incontinence scores (Mean score ± SD)
Aged ≥ 4 yr	10.70 ± 0.99	11.07 ± 1.05	0.16
Aged ≥ 5 yr	11.38 ± 0.62	11.52 ± 0.76	0.46
Aged ≥ 6 yr	11.71 ± 0.76	12.00 ± 0.83	0.35