Hirschsprung's Disease in Barbados A 16-year Review

Objective: To assess the surgical outcome of patients with Hirschsprung disease (HD) who were treated in Barbados, establish referral patterns and identify factors which can lead to better management. Design and Methods: All patients with HD who had definitive surgery at the Queen Elizabeth Hospital, Barbados, over a 16-year period (between July 1991 and June 2007) were identified from the hospital records system. Data from patients' notes were collected to establish demographics, including age at referral and definitive surgery, gender, presenting symptoms, surgical intervention(s) and definitive procedure. Long term outcome was assessed by the use of a simple questionnaire which was completed by the authors after personal or telephone contact with patients, their parents or guardians or the referring physician. Results: Between July 1991 and June 2007, 27 children were identified with HD. There were 20 males and seven females. Fifteen of the 2 7 children (55%) were local Barbadians, who were referred earlier when compared to those from the surrounding Caribbean islands. The most common mode of presentation was chronic constipation (13/27; 48%). The majority (69%) of the children were fully continent in the long-term (mean follow-up of 64 months) and passed a bowel motion on an average of 2-3 times per day without the use of laxatives or enemas. Conclusion: Children who had definitive surgery for HD in Barbados (using Martin modified Duhamel procedure) had an overall good long-term outcome comparable to international results. Children referred from the surrounding Caribbean islands were referred at an older age, but their overall outcome was not worse than local Barbadian patients.