Objective: To assess bowel function and gastrointestinal quality of life among adults with operated Hirschsprung's disease (HD). Summary Background Data: Outcomes of HD extending to adulthood are unclear; bowel function and quality of life may deteriorate by aging. Methods: Bowel function and gastrointestinal quality of life were cross-sectionally assessed in a population-based manner among adults operated for HD during childhood between 1950 and 1986. Patients were interviewed during their outpatient visit. Controls matched for age and sex were randomly chosen from the Population Register Centre of Finland. Results: Ninety-two (64%) patients representative for the entire study population responded. The mean age of patients (79% male) was 43 (interquartile range [IQR], 35–48) years. Most (78%) had undergone Duhamel operation, and 94% had aganglionosis confined to the rectosigmoid. The mean overall bowel function score was decreased among patients (17.1 ± 2.8 vs 19.1 ± 1.2; P < 0.0001). They reported increased incidence of inability to hold back defecation (40% vs 17%), fecal soiling (48% vs 22%), constipation (30% vs 9%) and social problems related to bowel function (29% vs 11%; P < 0.05 for all). Gastrointestinal quality of life was only marginally lower among patients (121 ± 15.3 vs 125 ± 13.1; P = 0.0578) mainly because of significantly lower scores in questions assessing disease-specific factors such as bowel function and continence. Age was the only predictor of poor bowel function (OR 1.07, 95% CI 1.00–1.14, P = 0.049), which weakly predicted gastrointestinal quality of life (OR 0.81, 95% CI 0.66–1.01, P = 0.055). Conclusions: Although bowel function deteriorates with increasing age after operated HD, it is associated with only slightly decreased gastrointestinal quality of life.

Congenital obstructive uropathy can lead to end stage renal disease. Progression to end stage renal disease in childhood is well described but long-term prognosis in adulthood has not been thoroughly investigated. In this study we evaluated the risk of end stage renal disease in patients with posterior urethral valves. During 1953 to 2003 a total of 200 male patients were treated for posterior urethral valves at our institution and of these 193 could be followed for renal outcome. Followup data on patients treated with dialysis or kidney transplantation were collected from patient records and the Finnish Kidney Transplantation Registry, and data on deceased patients were collected from hospital records and the Finnish Population Register Centre. Median patient age at evaluation was 31 years (range 6 to 69). Of the 193 patients followed 44 (22.8%) had progression to end stage renal disease. According to a Kaplan-Meier analysis the lifetime risk of end stage renal disease was 28.5% (SE 3.8%). No patient had end stage renal disease after the age of 34 years. The lowest serum creatinine value during postoperative year 1 was associated with speed of progression to end stage renal disease. Early presentation, pneumothorax, bilateral vesicoureteral reflux and recurrent urinary tract infections after the abolition of urethral obstruction were associated with an increased risk of end stage renal disease at followup. Congenital obstructive uropathy can lead to end stage renal disease during childhood or young adulthood. However, the risk of end stage renal disease seems to decrease eventually. Poor kidney function at presentation is associated with worse renal prognosis.

We assessed esophageal morbidity and relationships between surgical complications, symptoms, endoscopic findings, immunohistochemistry, and esophageal motility in adults with repaired esophageal atresia (EA). There exist no previous population-based long-term follow-up studies on EA. Participants were interviewed, and they underwent esophageal endoscopy and manometry. Matched control subjects (n = 287) served as controls. A total of 101 (42%) individuals representative of the entire study population participated at a mean age of 36 years (range, 21–57). Symptomatic gastroesophageal reflux had occurred in 34% and dysphagia in 85% of the patients and in 8% and 2% of the controls (P < 0.001 for both). Endoscopic findings included hiatal hernia (28%), Barrett′s esophagus (11%), esophagitis (8%), and anastomotic stricture (8%). Immunohistochemistry revealed esophagitis in 25%, and CDX2-positive columnar epithelial metaplasia in 21%, with additional goblet cells and MUC2 positivity in 6%. Gastroesophageal reflux and dysphagia were equally common in individuals with normal histology, esophagitis, or epithelial metaplasia. Manometry demonstrated nonpropagating peristalsis in 80% of the patients, and low distal wave amplitudes of the esophagus in all the changes being significantly worse in those with epithelial metaplasia (P ≤ 0.022 metaplasia vs. esophagitis/normal). Anastomotic complications (odds ratio [OR]: 8.6–24, 95% confidence interval [CI]: 1.7–260, P = 0.011–0.008), age (OR: 20, 95% CI: 1.3–310, P = 0.034), low distal esophageal body pressure (OR: 2.6, 95% CI: 0.7–10, P = 0.002), and defective esophageal peristalsis (OR: 2.2, 95% CI: 0.4–11, P = 0.014) predicted development of epithelial metaplasia. Significant esophageal morbidity associated with EA extends into adulthood. Surgical complications, increasing age, and impaired esophageal motility predict development of epithelial metaplasia after repair of EA.

OBJECTIVE. The role of laparoscopic surgery in pediatric inguinal hernia repair is unclear. We aimed to compare day-case laparoscopic hernia repair with open repair. METHODS. A prospective, single-blinded randomized study in children aged 4 months to 16 years with unilateral inguinal hernia was performed. The primary outcome measure was the time to normal daily activities after surgery. Secondary outcome measures included postoperative pain, time in the operation room, results, and complications. RESULTS. Eighty-nine patients were enrolled (laparoscopic hernia repair: 47, open repair: 42). The mean number of days to normal activity after laparoscopic hernia repair and open repair was 2.4 and 2.5, respectively. Thirty-seven (79%) patients with laparoscopic hernia repair and 20 (42%) with open repair required rescue analgesia postoperatively. The median pain score in the second postoperative morning was significantly higher after laparoscopic hernia repair. The median times in the operation room for laparoscopic hernia repair and open repair were 63 and 38 minutes, respectively. Surgical and cosmetic results were similar at up to 2 years' follow-up. CONCLUSIONS. Recovery and outcome were similar after open repair and laparoscopic hernia repair in children. Laparoscopic hernia repair was associated with increased theater time and postoperative pain.