Post‐operative anorectal manometry in children with Hirschsprung disease: A systematic review

Abstract

Background Hirschsprung disease is commonly encountered by pediatric surgeons. Despite advances in the surgical management, these children may experience symptoms of bowel dysfunction throughout adulthood. Anorectal manometry may be used to assess post‐operative anorectal structure and function. This review aimed to consolidate and evaluate the literature pertaining to post‐operative findings of anorectal manometry in children with Hirschsprung disease. Purpose (1) Synthesize the available data regarding anorectal motility patterns in children following repair of Hirschsprung disease. (2) Evaluate the reported anorectal manometry protocols. Data Sources We performed a systematic review of four databases: Embase, MEDLINE, the Cochrane Library, and PubMed. Study Selection This systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA). Studies reporting results of post‐operative anorectal manometry in children with Hirschsprung disease were evaluated for inclusion. Results Twenty‐three studies satisfied inclusion criteria, with a combined cohort of 939 patients. Post‐operative anorectal manometry results were reported for 682 children. The majority of included studies were assessed as “poor quality.” Disparate manometry protocols, heterogeneous cohorts, and lack of standardized outcome assessments introduced a risk of outcome reporting bias, limited the comparability of results, and impeded clinical translation of findings. Conclusions This systematic review demonstrated the lack of high‐quality evidence underlying the current understanding of post‐operative anorectal motility in children with HD. There was little consistency in reported manometry outcomes between studies. In future work, emphasis must be placed on the application of standardized manometry protocols, cohort reporting, and patient outcome assessments.

Diagnostic dilemma and challenges in management: Hirschsprung’s disease, anal stenosis and reduced interstitial cells of Cajal enteric mesenchymopathy

“…Apart from transit studies, anorectal manometry (ARM) and colonic manometry have been discussed as potentially useful tools in investigating complex chronic constipation cases 14. A systematic review has been published on the use of postoperative ARM in children with HD,15 which concluded that there is a lack of high-quality evidence underlying the current understanding of postoperative motility in children with HD. Perhaps, with more standardised manometry protocols and outcome reporting in the future, ARM could provide useful insight and guide further management of complex HD cases.…”

High-resolution anorectal manometry in children

“…Functioning RAIR is decrease in anal sphincter pressure of at least 20 mmHg following balloon dilatation [ 27 ]. Postoperative RAIR is not seen till approximately 32 months in Hirschsprung disease and is associated with variable outcomes [ 28 ].…”