Related Experiment Videos
Abnormalities of function and faecal water following the modified Soave operation for Hirschsprung's disease
Abstract:
Fourteen out of 18 patients (78%) had abnormal function 32 months after the modified Soave pull-through procedure for Hirschsprung's disease. The abnormalities were loose stools [9], perianal excoriation [7], soiling [11] and rectal prolapse [7]. Excoriation was caused by stools containing an excess of water, particularly in the "extractable" phase, with raised Na+ and Cl- concentrations, osmolality and hydrogen ion (pH) but normal concentration of K+. A deficiency of dry stool solid was also demonstrated. Abnormalities were most marked in patients who had high inferior mesenteric artery ligation and residual proximal left colon. Faecal water abnormalities are due to failure of complete water and electrolyte re-absorption by the pulled-through bowel. Manometric studies indicate that post-Soave patients have a small, "spastic" rectum with poor reservoir capacity which leads to soiling. Perianal excoriation occurs when faecal composition is abnormal. Four patients were improved on small doses of oral Ispaghula husk fibre. Clinical improvements were associated with alterations in stool composition.
Insights
Most patients (78%) experienced long-term bowel dysfunction after Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Colorectal Surgery
Background:
- Hirschsprung's disease is a congenital disorder characterized by the absence of ganglion cells in the distal bowel.
- The modified Soave pull-through procedure is a common surgical treatment for Hirschsprung's disease.
- Long-term functional outcomes after this procedure require further investigation.
Purpose of the Study:
- To evaluate the long-term functional outcomes and associated complications following the modified Soave pull-through procedure for Hirschsprung's disease.
- To investigate the characteristics of fecal abnormalities and their correlation with clinical symptoms.
- To explore potential therapeutic interventions for post-operative dysfunction.
Main Methods:
- Retrospective analysis of 18 patients who underwent the modified Soave pull-through procedure.
- Assessment of bowel function, including stool consistency, perianal excoriation, soiling, and rectal prolapse.
- Analysis of fecal composition (water, electrolytes, osmolality, pH, dry stool solid) and manometric studies of rectal function.
Main Results:
- 78% of patients (14/18) exhibited abnormal bowel function 32 months post-surgery, including loose stools, perianal excoriation, soiling, and rectal prolapse.
- Fecal abnormalities characterized by excess water, elevated Na+, Cl-, osmolality, and abnormal pH, with a deficiency in dry stool solid, were observed.
- Abnormalities were more pronounced in patients with high inferior mesenteric artery ligation and residual proximal left colon. Manometric studies revealed a small, spastic rectum with poor reservoir capacity.
Conclusions:
- The modified Soave pull-through procedure for Hirschsprung's disease is associated with a high incidence of long-term bowel dysfunction.
- Abnormal fecal water and electrolyte reabsorption by the pulled-through bowel, coupled with impaired rectal reservoir capacity, contribute to these functional issues.
- Oral Ispaghula husk fiber showed potential for improving symptoms and altering stool composition in a subset of patients.