What post-operative care and follow-up are necessary for patients who have undergone surgery for Hirschsprung's disease?

Post-operative care and follow-up for patients who have undergone surgery for Hirschsprung's disease should include tailored, multidisciplinary support focusing on bowel function monitoring, management of complications, and ongoing family education. Regular assessment of stool frequency, consistency, and continence is essential, using tools such as the Bristol Stool Form Scale to guide management and detect early signs of complications like enterocolitis or obstruction NICE CG99.

Children should have access to specialist paediatric healthcare professionals experienced in managing post-surgical Hirschsprung's disease to provide ongoing support, including advice on diet, fluid intake, and physical activity tailored to their developmental stage [1, Bokova et al. 2023].

Follow-up should include monitoring for symptoms of bowel dysfunction such as faecal incontinence or constipation, with early intervention to manage these symptoms through dietary modifications, laxatives, or enemas as appropriate [1, Ralls et al. 2017]. In cases of persistent or severe symptoms, referral to specialist surgical centres for consideration of redo pull-through surgery or other interventions may be necessary Ralls et al. 2017.

Additionally, patients with total colonic Hirschsprung's disease may require specific protocols addressing hypermotility and skin care to prevent complications, highlighting the need for individualized care plans Vilanova-Sanchez et al. 2020.

Psychological support should be considered if the child or family experiences significant distress related to bowel management, although routine psychological referral is not recommended unless clearly indicated NICE CG99.

Overall, post-operative care is a dynamic process requiring regular review and adjustment of management strategies to optimize bowel function and quality of life [1, Bokova et al. 2023].