Guidelines for the management of postoperative soiling in children with Hirschsprung disease

Saadai, Payam; Trappey, Alfred F.; Goldstein, Allan M.; Cowles, Robert A.; Torre, Luís de la; Durham, Megan M.; Huang, Eunice Y.; Levitt, Marc A.; Rialon, Kristy L.; Rollins, Michael D.; Rothstein, David H.; Langer, Jacob C.

doi:10.1007/s00383-019-04497-y

Cited by 45 publications

(62 citation statements)

References 12 publications

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“…The 3D-HR-ARM probe has 256 pressure sensors on 16 lines, each line having 16 circumferential sensors. The probe, covered with a disposable sheath, has a diameter of 10.75 mm, length of 64 mm and a 3.3 cm long balloon with a capacity up to 400 cm 3 . The preoperative study showed sphincter hypotonia and weak squeeze efforts.…”

Section: Operative Techniquementioning

confidence: 99%

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A technique to reconstruct the anal sphincters following iatrogenic stretching related to a pull-through for Hirschsprung disease

Krois

Reck

Darbari

et al. 2021

Journal of Pediatric Surgery

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Soiling and fecal incontinence are troubling complications which can occur after a pull-through for Hirschsprung disease. They can usually be improved with proper medical management, but in some cases are the result of an anatomic defect related to overstretching of the sphincters and/or damage of the anal canal. For such patients the treatment of this true fecal incontinence is limited to a structured bowel management program with ante-or retrograde enemas to achieve social continence. Herein we report two such patients with overstretched sphincters and loss of the dentate line after an initial pull-through and describe a sphincter tightening technique to improve bowel control.

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Section: Operative Techniquementioning

confidence: 99%

“…In the workup of those patients, it is essential to identify the cause of their symptoms. Abnormal sensation, inadequate sphincter control, and fast or slow colonic motility, can lead to soiling and fecal incontinence following a pull-through procedure [3] .…”

Section: Introductionmentioning

confidence: 99%

A technique to reconstruct the anal sphincters following iatrogenic stretching related to a pull-through for Hirschsprung disease

Krois

Reck

Darbari

et al. 2021

Journal of Pediatric Surgery

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“…Each of these symptom categories carries a distinct differential diagnosis. The American Pediatric Surgical Association Hirschsprung Disease Interest Group has recently released guidelines outlining algorithms for the workup and management of children with obstructive symptoms (17) and frequent soiling (18). The various etiologies leading to the dysfunctional pullthrough are summarized in Table 1.…”

Section: Dysfunctional Stooling After Pull-throughmentioning

confidence: 99%

Reoperative techniques and management in Hirschsprung disease: a narrative review

Demehri

Dickie

2021

Transl Gastroenterol Hepatol

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The majority of children who undergo operative management for Hirschsprung disease have favorable results. A subset of patients, however, have long-term dysfunctional stooling, characterized by either frequent soiling or obstructive symptoms. The evaluation and management of a child with poor function after pull-through for Hirschsprung disease should be conducted by an experienced multidisciplinary team. A systematic workup is focused on detecting pathologic and anatomic causes of pullthrough dysfunction. This includes an exam under anesthesia, pathologic confirmation including a repeat biopsy, and a contrast enema, with additional studies depending on the suspected etiology. Obstructive symptoms may be due to technique-specific types of mechanical obstruction, histopathologic obstruction, or dysmotility-each of which may benefit from reoperative surgery. The causes of soiling symptoms include loss of the dentate line and damage to the anal sphincter, which generally do not benefit from revision of the pull-through, and pseudo-incontinence, which may reveal underlying obstruction. A thorough understanding of the types of complications associated with various pull-through techniques aids in the evaluation of a child with postoperative dysfunction. Treatment is specifically tailored to the patient, guided by the etiology of the patient's symptoms, with options ranging from bowel management to redo pull-through procedure. This review details the workup and management of patients with complications after pull-through, with a focus on the perioperative management and technical considerations for those who require reoperation.

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“…This paper from the APSA Hirschsprung disease Interest Group [1] shows very well the current protocols for investigation and treatment of soiling in children after surgery for Hirschsprung disease (HD). The authors classify the causes into three main categories: sensory deficiency, abnormal sphincter control and 'pseudo-incontinence.…”

mentioning

confidence: 98%

“…Our group has been researching the causes of RTC recently, and in both HD and otherwise normal children with RTC, breath tests have identified malabsorption of one or more of the 'FODMAP' sugars. We have now treated many children with positive breath tests with exclusion diets, eliminating the specific sugar(s), with a marked improvement in their symptoms [1][2][3].…”

mentioning

confidence: 99%

Letter to the Editor regarding: Guidelines for the management of postoperative soiling in children with Hirschsprung disease, Saadai et al. PSI (2019)35: 829–834

Hutson

2019

Pediatr Surg Int

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Guidelines for the management of postoperative soiling in children with Hirschsprung disease

Cited by 45 publications

References 12 publications

A technique to reconstruct the anal sphincters following iatrogenic stretching related to a pull-through for Hirschsprung disease

A technique to reconstruct the anal sphincters following iatrogenic stretching related to a pull-through for Hirschsprung disease

Reoperative techniques and management in Hirschsprung disease: a narrative review

Letter to the Editor regarding: Guidelines for the management of postoperative soiling in children with Hirschsprung disease, Saadai et al. PSI (2019)35: 829–834

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