Importance of anorectal manometry after definitive surgery for Hirschsprung′s disease in children

Demirbağ, Suzi; Tiryaki, Tuğrul; Purtuloglu, Tarik

doi:10.4103/0189-6725.109370

Cited by 17 publications

(26 citation statements)

References 18 publications

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“…A Duhamel pull‐through comprises excision of the aganglionic segment of bowel with anastomosis of proximal ganglionic bowel to the short retained aganglionic segment immediately proximal to the anal sphincter. As a result of disruption of the intrinsic nervous system, patients post‐Duhamel's procedure has an absent RAIR . Only a few studies suggest that the RAIR might be restored post‐Duhamel .…”

Section: Discussionmentioning

confidence: 99%

Preservation of the colo‐anal reflex in colonic transection and post‐operative Hirschsprung's disease: Potential extrinsic neural pathway

Sintusek

Rybak

Mutalib

et al. 2018

Neurogastroenterology Motil

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Background The colo‐anal reflex is a distinct reflex whereby the internal anal sphincter (IAS) relaxes in association with colonic high amplitude propagating contractions (HAPCs) in contrast to the recto‐anal inhibitory reflex (RAIR), which is characterized by IAS relaxation upon rectal distension. The RAIR is mediated by the myenteric plexus and therefore absent in Hirschsprung disease. We retrospectively assessed the presence and the characteristics of the colo‐anal reflex in children in whom large bowel continuity had been surgically disrupted to assess the role of the extrinsic nervous system in the reflex. Methods High‐resolution (HR) colonic manometry and HR‐anorectal manometry were used to evaluate both colonic and anal motor activity in ten children with treatment‐unresponsive slow transit constipation (STC), who had previously undergone left‐sided colostomy formation with consequent disruption of the bowel continuity, and in two children with Hirschsprung's disease (HSCR), who had previously undergone distal colon resection followed by Duhamel pull‐through. Eight children with STC, normal colonic motor activity, and preserved large bowel continuity served as a control group. The presence and characteristics of colo‐anal reflex were analyzed. Key Results In the study group, all patients showed the presence of both normal HAPCs and the presence of the colo‐anal reflex. In two cases of HSCR, RAIR was absent; however, both patients demonstrated a colo‐anal reflex. Conclusions In children with disrupted continuity of the colon and/or abnormal anal reflex, the colo‐anal reflex is still preserved suggesting that it is mediated by a different pathway from the RAIR, possibly an extrinsic neural pathway.

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Section: Discussionmentioning

confidence: 99%

Preservation of the colo‐anal reflex in colonic transection and post‐operative Hirschsprung's disease: Potential extrinsic neural pathway

Sintusek

Rybak

Mutalib

et al. 2018

Neurogastroenterology Motil

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“…However, there are few reports about anorectal manometry during follow-up of children operated on for HD, and its role still seems controversial in terms of the uses of different anorectal manometry systems (conventional versus high-resolution anorectal manometry [HRAM]), lack of normal value, particularly the reference value of HRAM in HD patients. 9,10,14,15 Therefore, this study aimed at investigating the anorectal manometry findings in our patients after operation for HD while considering their longterm bowel function. Regarding our long-term outcome survey, we report findings similar to those described in the literature, that is, defecation disorders remain problematic issues and challenges in a high percentage of the patients even until adulthood, significantly altering their quality of life, especially in cases with fecal incontinence.…”

Section: Discussionmentioning

confidence: 99%

“…[9][10][11][12][13] Otherwise little is known about anorectal manometry in patients after surgery for HD. 9,10,14,15 Therefore, this study aims at investigating anorectal manometry findings of patients operated on for HD and the relationship with their outcomes.…”

Section: Introductionmentioning

confidence: 99%

Interest of Anorectal Manometry During Long-term Follow-up of Patients Operated on for Hirschsprung's Disease

Tran

Mahler

Bontems

et al. 2018

J Neurogastroenterol Motil

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Background/AimsAlthough many advances in the management of Hirschsprung's disease have recently been achieved, postoperative outcomes of these patients remain difficult in a non-negligible number of cases. Therefore, this study aims at investigating characteristics of anorectal manometry and its relationship with postoperative outcomes during long-term follow-up in Hirschsprung patients. MethodsPatients over 4 years of age operated on for Hirschsprung's disease were interviewed to complete detailed questionnaires on bowel function. The patients who consented to undergo an anorectal manometry during follow-up were enrolled in this study. We investigated their clinical characteristics, manometric findings, and their postoperative bowel function. ResultsNineteen patients out of 53 patients (35.8%) were enrolled, 68.4% who were male. Mean age of patients at manometry was 11.3 ± 6.3 years. Twelve out of 19 patients (63.2%) were incontinent. The mean anal resting pressures of incontinent patients were significantly lower than continent patients (47 ± 12 mmHg versus 63 ± 11 mmHg, P < 0.05, t test). Due to neurological impairment, only 11 patients (57.9%) were able to perform a complete manometry. A dyssynergic defecation was found in 4 patients during strain tests. Maximum tolerated volume of the incontinent patients was significantly lower than that of the continent patients (97 ± 67 mL versus 181 ± 74 mL, P < 0.05, t test). ConclusionAnorectal manometry is an objective method providing useful information that could guide a more adapted management in patients with defecation disorders after Hirschsprung's disease operation.

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“…Evaluation of RAIR can also be useful in children with suspected anal achalasia. The RAIR is classically absent in patients with Hirschsprung's disease, anal sphincter achalasia and after circular rectal myomectomy or complex imperforate anus repair. To evaluate patients with anorectal malformations with persistent defecation problems after surgical repair. To assess persistent defecation problems after surgery for Hirschsprung's disease . Because the anal sphincter is dysfunctional in all children with Hirschsprung's disease and the RAIR remains absent after surgery, patients can experience difficult stool expulsion and chronic constipation.…”

Section: Indicationsmentioning

confidence: 99%

“…Hirschsprung's disease. 38,39 Because the anal sphincter is dysfunctional in all children with Hirschsprung's disease and the RAIR remains absent after surgery, patients can experience difficult stool expulsion and chronic constipation. In patients with Hirschsprung's disease with fecal incontinence following surgical repair the measurement of the length of the anal canal may be of relevance.…”

Section: To Assess Persistent Defecation Problems After Surgery Formentioning

confidence: 99%

An ANMS‐NASPGHAN consensus document on anorectal and colonic manometry in children

Rodriguez

Sood

Lorenzo

et al. 2016

Neurogastroenterology Motil

122

190

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Importance of anorectal manometry after definitive surgery for Hirschsprung′s disease in children

Cited by 17 publications

References 18 publications

Preservation of the colo‐anal reflex in colonic transection and post‐operative Hirschsprung's disease: Potential extrinsic neural pathway

Preservation of the colo‐anal reflex in colonic transection and post‐operative Hirschsprung's disease: Potential extrinsic neural pathway

Interest of Anorectal Manometry During Long-term Follow-up of Patients Operated on for Hirschsprung's Disease

An ANMS‐NASPGHAN consensus document on anorectal and colonic manometry in children

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