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Colonic motility after surgery for Hirschsprung's disease
C Di Lorenzo1, G F Solzi, A F Flores
1Division of Pediatric Gastroenterology, Children's Hospital of Pittsburgh, Pennsylvania 15213, USA.
Insights
Colonic manometry helps identify specific motility issues in children with Hirschsprung's disease, guiding effective treatments for persistent bowel problems after surgery.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Physiology
Background:
- Children undergoing surgery for Hirschsprung's disease often experience long-term fecal incontinence or constipation.
- Understanding the underlying physiological mechanisms is crucial for managing these persistent symptoms.
Purpose of the Study:
- To define the physiology of persistent symptoms in children post-Hirschsprung's disease surgery.
- To determine the effectiveness of interventions guided by colonic motility testing.
Main Methods:
- 46 symptomatic children, over 10 months post-surgery for Hirschsprung's disease, were studied.
- Colonic manometry was performed with a catheter in the proximal colon.
- Patients were followed up for an average of 34 months post-manometry using questionnaires and interviews.
Main Results:
- Four distinct motility patterns were identified, correlating with specific symptoms like fecal soiling or constipation.
- Treatment based on manometry results led to significant improvements in global and emotional health.
- 72% of children experienced improved bowel movement frequency, and 80% reported reduced abdominal pain.
Conclusions:
- Colonic manometry is effective in clarifying the pathophysiology of post-surgical Hirschsprung's disease symptoms.
- Motility testing directs targeted interventions, improving outcomes for affected children.
Objective:
Years after surgery for Hirschsprung's disease, many children continue to suffer from fecal incontinence or constipation. The purpose of the present investigation was to define the physiology underlying the persistent symptoms in children after surgery for Hirschsprung's disease, and to determine the outcome of interventions based on the results of the motility testing.
Methods:
We studied 46 symptomatic patients (5.5+/-3.3 yr old, 35 male) >10 months after surgery for Hirschsprung's disease. We performed a colonic manometry with a catheter placed with the tip in the proximal colon. We used a structured questionnaire and phone interview to follow up the patients an average of 34 months after the manometry.
Results:
We identified four motility patterns: 1) high-amplitude propagating contractions (HAPCs) migrating through the neorectum to the anal sphincter, associated with fecal soiling (n = 18); 2) normal colonic manometry associated with fear of defecation and retentive posturing (n = 9); 3) absence of HAPCs or persistent simultaneous contractions over two or more recording sites (n = 15), associated with constipation (n = 13); and 4) normal colonic motility and a hypertensive internal anal sphincter (>80 mm Hg) (n = 4). We based treatment on results of the motility studies. There was improvement in global health (mean score, 3.9+/-1.1 vs 2.8+/-1.3 at the time of initial evaluation, p < 0.001) and emotional health (3.8+/-1.1 vs 2.6+/-1.1, p < 0.0001). Improvement in the number of bowel movements occurred in 72% of children. Resolution or decreased abdominal pain was reported in 80%.
Conclusions:
Colonic manometry clarifies the pathophysiology and directs treatment in symptomatic children after surgery for Hirschsprung's disease.