CLINICAL OUTCOMES EVALUATIONS OF CONGENITAL MEGACOLON (HIRSCHSPRUNG DISEASE) SHORT SEGMENT TYPE AFTER TRANSANAL ENDORECTAL PULL THROUGH (TEPT) AT MOEWARDI HOSPITAL SURAKARTA
Erwin Aritama Ismail1 , Suwardi2, Ida Bagus Budhi SA3, Nunik Agustriani2, Amru Sungkar4, Setya Anton Tusarawardaya5
1Surgery Resident, Medical Faculty Sebelas Maret University, Moewardi Hospital, Surakarta, Indonesia
2Pediatric Surgery Division, Department of Surgery Medical Faculty Sebelas Maret University, Moewardi Hospital, Surakarta, Indonesia
3Digestive Surgery Division, Department of Surgery Medical Faculty Sebelas Maret University, Moewardi Hospital, Surakarta, Indonesia
4Platic Surgery Division, Department of Surgery Medical Faculty Sebelas Maret University, Moewardi Hospital, Surakarta, Indonesia
5Urology Division, Department of Surgery Medical Faculty Sebelas Maret University, Moewardi Hospital, Surakarta, Indonesia

ABSTRACT
Backgrounds: The incidence of congenital megacolon is 1 in 5000 live births. In Indonesia it is estimated that 1200 babies with congenital megacolon will be born each year and the ratio of males to females is 4:1. Mortality and morbidity of patients with congenital megacolon might be reduced by improvement in diagnosis, neonatal intensive care, surgical techniques and management of congenital megacolon accompanied by enterocolitis. Currently, common definitive surgical procedure for congenital megacolon is Transanal Endorectal Pull Trough (TEPT) procedure, which is a development of the concept of minimally invasive surgery in a transanal way without the need for laparotomy or laparoscopy and can be performed from the neonatal period. Following the TEPT  treatment, there is a reduction in the length of the patient's intestinal segment. Consequently, this alteration may lead to the occurrence of anorectal dysfunction in the post-TEPT period. The most optimal method for evaluating anorectal outcome and function subsequent to TEPT  is the assessment of fecal continence.
Aims: Understand of the clinical outcome congenital megacolon (hirschsprung disease) short segment type after transanal endorectal pull through (TEPT) procedure at Moewardi Hospital, Surakarta.
Method: Patients with a diagnosis of congenital megacolon short segment type who received TEPT at Moewardi Hospital from 2010 – 2022 who were less aged than 11 years and had at least 6 months or more of post TEPT procedure. Data included patient age, age when the surgery performed, and age at follow-up of anorectal function, which usually at 6 months. Fecal continence was measured using a questionnaire based on the Heikkinen scoring system. 
Results: There were 37 patients diagnosed with congenital megacolon short segment type who received TEPT from 2010 – 2022 who were included in the inclusion criteria. The data revealed that anorectal function was normal in 7 patients (18.9%), good continence in 20 patients (54.1%), moderate continence in 9 patients (24.3%), and incontinence in 1 patient. (2.7%). At the time of operation, the age distribution for congenital megacolon short segment type patients was largely between 1 and 12 months, with a total of 24 patients (64.9%). The most common outcome of anorectal function in congenital megacolon short segment type patients was good continence at the age of surgery 1-12 months, which occurred in 23 patients (62.2%). The average age of the patients at the time of follow-up in this study was 1-5 years, with 29 patients (78.4%). Good continence at the age of 1-5 years was the most prevalent outcome of anorectal function in congenital megacolon short segment type patients, with as many as 18 patients (48.6%) achieving it. The patients were primarily male, with 31 patients (86.1%), good continence was the most prevalent outcome for anorectal function in this category, with 16 patients (43.2%). The Pearson Chi-Square score is 0.001 (0.05), indicating that age at the time of surgery is strongly related to anorectal function results. Therefore, the hypothesis in this study, which claims that there is a relationship between age at the time of surgery and the outcome of anorectal function in congenital megacolon short segment type patients after the TEPT treatment at Moewardi Hospital in Surakarta, has been supported by the results of empirical research.
Conclusion: The patients that diagnosed with congenital megacolon short segment type who underwent a transanal endorectal pullthrough procedure exhibited favorable outcomes in terms of anorectal function, with low occurrence of anorectal function problems. A significant correlation has been observed between the age at when surgery was performed with congenital megacolon short segment type and the outcome of anorectal function following the transanal endorectal pull through procedure. 
Keywords: congenital megacolon, transanal endorectal pullthrough, fecal incontinence outcomes.