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The Hirschsprungs patient who is soiling after what was considered a "successful" pull-through
Marc A Levitt1, Belinda Dickie, Alberto Peña
1Colorectal Center for Children, Cincinnati Children's Hospital Medical Center, Division of Pediatric Surgery, Department of Surgery, University of Cincinnati, Cincinnati, OH 45229, USA. marc.levitt@cchmc.org
Insights
Most children recover well after Hirschsprung disease surgery. A small group may experience ongoing issues like abdominal distention and enterocolitis, but can be treated with bowel management and dietary changes.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Hirschsprung disease surgery aims for good outcomes, including fecal continence and absence of complications.
- A subset of patients experience persistent or recurrent abdominal distention, enterocolitis, or soiling post-operatively.
Purpose of the Study:
- To describe the challenges faced by a subgroup of patients after Hirschsprung disease surgery.
- To outline a systematic approach for evaluating and managing these challenging cases.
Main Methods:
- Systematic evaluation of patients with poor outcomes post-Hirschsprung surgery.
- Implementation of a multi-modal treatment strategy including bowel management, dietary modifications, and laxatives.
- Consideration of reoperation in select cases.
Main Results:
- Successful management of persistent abdominal distention and enterocolitis.
- Improvement in fecal soiling for patients undergoing pull-through procedures.
- Demonstration that a combination of conservative and surgical interventions can yield positive results.
Conclusions:
- While most children achieve excellent outcomes after Hirschsprung disease surgery, a structured approach is necessary for those who do not.
- Bowel management, dietary changes, laxatives, and potentially reoperation are effective strategies for managing complex cases.
Abstract:
After surgery for Hirschsprungs disease, most children thrive, have few if any episodes of abdominal distention and enterocolitis, and are fecally continent. However, there exists a small group of patients who do not do well. Either they suffer from persistent distension and enterocolitis or they experience soiling after their pull-through procedure. These patients can be systematically evaluated and successfully treated with a combination of bowel management, dietary changes, and laxatives, and, in certain circumstances, a reoperation.
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