Comparison of Hirschsprung-Associated Enterocolitis Frequency After Transanal Swenson-Like and Transanal Endorectal Pull-Through at RSUP Dr. Sardjito

Azzahra Fatinnuha Azmi Prayogi Putri, Prof. dr. Gunadi., Ph.D, Sp.BA, Subsp.D.A (K); dr. Kristy Iskandar, M.Sc, Ph.D, Sp.A, Subsp.Neuro (K)

2025 | Skripsi | PENDIDIKAN DOKTER

Latar Belakang: Penyakit Hirschsprung (HSCR) adalah kelainan genetik yang menyebabkan gangguan pergerakan usus pada bayi akibat perkembangan sistem saraf usus yang terganggu. Hirschsprung-Associated Enterocolitis (HAEC) adalah komplikasi pascaoperasi yang secara signifikan berkontribusi terhadap angka kematian pasien. Prosedur pull-through yang umum digunakan untuk menangani HAEC adalah transanal endorectal pull-through (TEPT). Metode transanal Swenson-like pull-through (TSLPT) merupakan teknik yang lebih baru, mengombinasikan teknik Swenson dengan posterior sagittal anorectoplasty, menawarkan hasil yang lebih baik serta pendekatan yang aman dan efektif.

Tujuan: Membandingkan frekuensi HAEC pasca-TSLPT dan TEPT pada pasien HSCR serta menghubungkannya dengan faktor risiko prognostik, seperti jenis kelamin, usia saat operasi, status gizi, kadar hemoglobin, dan albumin pascaoperasi.

Metode: Pasien dengan HSCR yang menjalani TSLPT dan TEPT di RS Dr. Sardjito, Indonesia, antara tahun 2018 dan 2023 akan ditinjau secara retrospektif melalui rekam medis. Diagnosis HAEC ditentukan menggunakan sistem penilaian HAEC dengan nilai batas (cut-off) 10 dan 4. Data akan disajikan sebagai angka dan persentase untuk variabel kategorik. Uji Chi-square akan digunakan untuk mengevaluasi perbedaan frekuensi HAEC antara kedua kelompok.

Hasil: Sebanyak 29 pasien menjalani TSLPT, dan 41 pasien menjalani TEPT untuk HSCR. Dengan nilai batas 10, HAEC terdiagnosis pada masing-masing 1 dan 4 kasus. Dengan nilai batas 4, HAEC terdiagnosis pada masing-masing 2 dan 10 kasus. Faktor prognostik seperti jenis kelamin, usia saat operasi, jenis aganglionosis, dan kadar hemoglobin tidak menunjukkan signifikansi statistik pada kejadian HAEC setelah TSLPT dan TEPT menggunakan nilai batas 10 maupun 4. Sebaliknya, kadar albumin menunjukkan signifikansi statistik pada TEPT menggunakan nilai batas 4.

Kesimpulan: Frekuensi HAEC lebih tinggi setelah prosedur transanal endorectal pull- through dibandingkan dengan transanal Swenson-like pull-through. Namun, perbedaannya tidak signifikan secara statistik. Selain itu, hanya kadar albumin yang menunjukkan signifikansi statistik sebagai faktor prognostik pada pasien pasca-TEPT dengan nilai batas 4.

Kata Kunci: Hirschsprung disease, HAEC, transanal Swenson-like pull- through, transanal endorectal pull-through

Background: Hirschsprung's disease (HSCR) is a genetic disorder causing bowel movement problems in babies due to impaired intestinal nervous system development. Hirschsprung-Associated Enterocolitis (HAEC) is a complication that occurs postoperatively, contributing significantly to patient mortality. The leading pull-through procedure to treat HAEC is transanal endorectal pull-through (TEPT). The transanal Swenson-like pull-through (TSLPT) is a more recent method that combines the Swenson technique with posterior sagittal anorectoplasty, offering superior outcomes and a safe, effective approach.

Objective: To compare the HAEC frequency following TSLPT and TEPT in HSCR patients and associate them with prognostic risk factors, including sex, age at surgery, nutritional status, post-operative hemoglobin and albumin level.

Method: Patients with HSCR who underwent TSLPT and TEPT at Dr. Sardjito in Indonesia between 2018 and 2023 will have their medical records reviewed retrospectively. The diagnosis of HAEC is determined using a HAEC scoring system using cut-offvalues of 10 and 4. Data will be presented as numbers and percentages for categorical variables. The Chi square test will be used to evaluate the differences in HAEC frequency between two groups.

Results: A total of 29 patients underwent TSLPT and 41 patients underwent TEPT for HSCR. Using a cut-off value of 10, HAEC was diagnosed in 1 and 4 cases, respectively. With a cut-off value of 4, HAEC was diagnosed in 2 and 10 cases, respectively. Prognostic factors such as sex, age at surgery, type of aganglionosis, and hemoglobin level did not exhibit statistical significance in HAEC after both TSLPT and TEPT using cut-off values of 10 and 4. In contrast, albumin level showed statistical significance in TEPT using a cut-off value of 4.

Conclusion: The frequency of HAEC is higher after transanal endorectal pull-through compared to transanal Swenson-like pull-through. However, the difference is not statistically significant. Furthermore, only albumin level exhibits statistical significance as a prognostic factor in post-TEPT patients using a cut-off value of 4.

Keywords: Hirschsprung’s disease, HAEC, transanal Swenson-like pull-through, transanal endorectal pull-through

Kata Kunci : Hirschsprung’s disease, HAEC, transanal Swenson-like pull-through, transanal endorectal pull-through