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Post-operative anorectal manometry in children with Hirschsprung disease: A systematic review
Hannah M E Evans-Barns1,2,3, Justina B Swannjo3, Misel Trajanovska1,2
1Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia.
Insights
Post-operative anorectal manometry in children with Hirschsprung disease (HD) lacks high-quality evidence. Current studies show inconsistent results due to varied protocols, hindering clinical application.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Research Methodology
Background:
- Hirschsprung disease (HD) often requires surgical intervention in childhood.
- Post-operative bowel dysfunction can persist into adulthood for individuals with HD.
- Anorectal manometry is a tool to assess post-surgical anorectal function.
Purpose of the Study:
- To synthesize data on anorectal motility patterns after surgical repair of Hirschsprung disease in children.
- To evaluate the methodologies of anorectal manometry protocols used in post-operative Hirschsprung disease assessments.
Main Methods:
- A systematic review was conducted across Embase, MEDLINE, Cochrane Library, and PubMed.
- Studies reporting post-operative anorectal manometry in pediatric Hirschsprung disease patients were included.
- The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Main Results:
- Twenty-three studies involving 939 patients met the inclusion criteria.
- Anorectal manometry results were available for 682 children.
- Most studies were of poor quality, with inconsistent protocols and outcomes, limiting comparability and clinical translation.
Conclusions:
- There is a significant lack of high-quality evidence on post-operative anorectal motility in children with Hirschsprung disease.
- Inconsistent manometry outcomes across studies highlight the need for standardization.
- Future research should prioritize standardized manometry protocols, cohort reporting, and outcome assessments.
Background:
Hirschsprung disease is commonly encountered by pediatric surgeons. Despite advances in the surgical management, these children may experience symptoms of bowel dysfunction throughout adulthood. Anorectal manometry may be used to assess post-operative anorectal structure and function. This review aimed to consolidate and evaluate the literature pertaining to post-operative findings of anorectal manometry in children with Hirschsprung disease.
Purpose:
(1) Synthesize the available data regarding anorectal motility patterns in children following repair of Hirschsprung disease. (2) Evaluate the reported anorectal manometry protocols.
Data Sources:
We performed a systematic review of four databases: Embase, MEDLINE, the Cochrane Library, and PubMed.
Study Selection:
This systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies reporting results of post-operative anorectal manometry in children with Hirschsprung disease were evaluated for inclusion.
Results:
Twenty-three studies satisfied inclusion criteria, with a combined cohort of 939 patients. Post-operative anorectal manometry results were reported for 682 children. The majority of included studies were assessed as "poor quality." Disparate manometry protocols, heterogeneous cohorts, and lack of standardized outcome assessments introduced a risk of outcome reporting bias, limited the comparability of results, and impeded clinical translation of findings.
Conclusions:
This systematic review demonstrated the lack of high-quality evidence underlying the current understanding of post-operative anorectal motility in children with HD. There was little consistency in reported manometry outcomes between studies. In future work, emphasis must be placed on the application of standardized manometry protocols, cohort reporting, and patient outcome assessments.
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