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Post-operative colonic manometry in children with Hirschsprung disease: A systematic review
Hannah M E Evans-Barns1,2,3, Justina Swannjo3, Misel Trajanovska1,2,3
1Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia.
Insights
Children with Hirschsprung disease (HD) often have bowel issues after surgery. This review found limited evidence on colonic manometry for assessing motility problems in these patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Medical Device Technology
Background:
- A significant number of children experience persistent bowel dysfunction, including constipation and fecal incontinence, after surgical repair of Hirschsprung disease (HD).
- Underlying colonic and/or anorectal dysmotility is suspected as the cause of these ongoing symptoms.
- Colonic manometry is a potential diagnostic tool to investigate gastrointestinal motility patterns in this patient population.
Purpose of the Study:
- To evaluate the equipment and protocols used for colonic manometry in assessing children post-operative Hirschsprung disease.
- To summarize existing evidence on colonic motility patterns in children with repaired Hirschsprung disease.
Main Methods:
- A systematic review of multiple databases (Cochrane Library, Embase, MEDLINE, PubMed) was conducted from January 1, 1980, to March 9, 2020.
- Studies involving post-operative assessment of children with Hirschsprung disease using colonic manometry were included, adhering to PRISMA guidelines.
- Data extraction was performed independently by two authors.
Main Results:
- Five studies met the inclusion criteria, encompassing a total of 496 children, with 184 undergoing colonic manometry.
- Significant heterogeneity was observed in study populations, manometry equipment, and protocols, limiting direct comparisons.
- All included studies utilized low-resolution colonic manometry.
Conclusions:
- There is a notable lack of evidence regarding colonic dysmotility in children following surgical repair of Hirschsprung disease.
- Current research is constrained by variable methodologies, diverse patient cohorts, and the absence of high-resolution manometry techniques.
Background:
A significant proportion of children experience bowel dysfunction (including constipation and fecal incontinence) following surgical repair of Hirschsprung disease (HD). Persistent symptoms are thought to relate to underlying colonic and/or anorectal dysmotility. Manometry may be used to investigate the gastrointestinal motility patterns of this population.
Purpose:
To (1) evaluate the colonic manometry equipment and protocols used in the assessment of the post-operative HD population and (2) summarize the available evidence regarding colonic motility patterns in children with HD following surgical repair.
Data Sources:
We performed a systematic review of the Cochrane Library, Embase, MEDLINE, and PubMed databases (January 1, 1980 and March 9, 2020). Data were extracted independently by two authors.
Study Selection:
This systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies reporting the post-operative assessment of children with HD using colonic manometry were considered for inclusion.
Results:
Five studies satisfied selection criteria, providing a combined total of 496 children. Of these, 184 children with repaired HD underwent colonic manometry. Studies assessed heterogeneous populations, utilized variable manometry equipment and protocols, and reported limited baseline symptom characteristics, thus restricting comparability. All studies used low-resolution colonic manometry.
Conclusions:
This systematic review highlighted the paucity of evidence informing the understanding of colonic dysmotility in the post-operative HD cohort. Current literature is limited by variable methodologies, heterogeneous cohorts, and the lack of high-resolution manometry.
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