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Anorectal manometric evaluation of children and adolescents postsurgery for Hirschsprung's disease
Carlos Zaslavsky1, Vera Loening-Baucke
1Hospital da Crianca Santo Antonio and Hospital Materno Infantil Presidente Vargas, Porto Alegre, Brazil.
Insights
Anorectal manometry after Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Urology
Background:
- Anorectal function post-Hirschsprung's disease surgery is poorly understood.
- Evaluating sphincter function is crucial for patient outcomes.
Purpose of the Study:
- To assess anorectal sphincter function in patients following corrective surgery for Hirschsprung's disease.
- To correlate manometric findings with clinical outcomes.
Main Methods:
- Anorectal manometry performed on 35 patients post-surgery.
- Pre- and post-operative manometry in 16 patients.
- Evaluation of clinical outcome, anal resting pressure, rectosphincteric reflex (RSR), and propulsive waves.
Main Results:
- 89% of patients had poor clinical outcomes 4.4 years post-surgery.
- RSR was absent in 33 patients and abnormal in 2.
- No significant difference in anal resting pressure based on surgical approach or sphincterotomy.
Conclusions:
- Persistent absence of RSR is common years after Hirschsprung's disease surgery.
- Propulsive waves did not predict bowel control.
- Surgical technique did not significantly impact anal resting pressure.
Background:
Little is known about anorectal function in patients after surgery for Hirschsprung's disease. Therefore, the authors evaluated anorectal sphincter function after corrective surgery.
Methods:
Thirty-five patients were studied after corrective surgery for Hirschsprung's disease. Sixteen of them had anorectal manometry performed also before surgery. The clinical outcome, the highest anal resting pressure, the presence of the rectosphincteric reflex (RSR), and of high amplitude propulsive waves were evaluated.
Results:
A total of 89% were doing poorly. Three had a fair and only one had a good outcome at the time of manometry 4.4 years after corrective surgery. RSR was absent in 33 and abnormal in 2 patients. The preoperative anal resting pressure was 45 +/- 14 mm Hg and postoperatively 45 +/- 13 mm Hg (P >.3). The anal resting pressure was 44 +/- 16 mm Hg in the 19 patients evaluated only postoperatively. Propulsive waves > or =50 mm Hg were present in 60% of patients.
Conclusions:
Four years postsurgery, patients had a persistent absence of RSR regardless of the type of surgery. There was no significant difference in anal resting pressure between patients with and without sphincterotomy or between different surgical procedures. The presence of propulsive waves was not a prognostic indicator for achieving bowel control.
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