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Anal canal and sphincter function in children with Hirschsprung disease after definitive surgery
Wei Sheng Tan1, Zulfitri Md Hasan2, Anand Sanmugam1
1Division of Paediatric Surgery, Department of Surgery, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia.
Insights
Anorectal manometry findings did not significantly correlate with bowel function outcomes in children after Hirschsprung Disease surgery. Further research is needed due to the small sample size.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Urology
Background:
- Hirschsprung Disease (HD) requires surgical pullthrough, impacting anorectal function.
- Objective evaluation of post-operative anorectal function is crucial but understudied.
- Anorectal manometry (ARM) offers objective functional assessment.
Purpose of the Study:
- To investigate high-resolution anorectal manometry (HRAM) findings in pediatric patients post-HD pullthrough.
- To determine the association between HRAM parameters and clinical bowel function outcomes.
- To evaluate the presence of the recto-anal inhibitory reflex (RAIR) post-surgery.
Main Methods:
- Prospective observational study of 32 HD patients post-definitive pullthrough.
- High-resolution anorectal manometry (HRAM) measured anal resting pressure (ARP) and high-pressure zone (HPZ) length.
- Paediatric Incontinence/Constipation Scoring System (PICSS) assessed bowel function; statistical analysis compared manometry and clinical data.
Main Results:
- No statistically significant differences in ARP or HPZ were found across different PICSS bowel function groups.
- The recto-anal inhibitory reflex (RAIR) was present in 37.5% of patients.
- No significant association was observed between RAIR presence and PICSS bowel function categories.
Conclusions:
- Bowel function after HD pullthrough surgery does not appear significantly associated with HRAM findings.
- The limited sample size restricts definitive conclusions.
- RAIR is present in a subset of patients, warranting further investigation.
Introduction:
Anorectal manometry may be useful to objectively evaluate anorectal function following definitive pullthrough for Hirschsprung Disease (HD) but there is little published data. Our study aims to investigate anorectal manometry findings and their association with bowel function.
Methodology:
This was a prospective observational study. Convenience sampling method was used to recruit all HD patients who had definitive pullthrough from January 2019 to December2020 in our institution. High-resolution anorectal manometry (HRAM) was used to record anal resting pressure (ARP), length of high-pressure zone (HPZ), and presence/absence of recto-anal inhibitory reflex (RAIR). The Paediatric Incontinence/Constipation Scoring System (PICSS) was scored for all participants. PICSS is a validated questionnaire with scores mapped to an age-specific normogram to denote constipation, incontinence, and their combinations. Non-parametric and chi-square tests at significance p<0.05 were conducted to examine the relationship between PICSS categories and manometry findings. Ethical approval was obtained.
Results:
There were 32 participants (30 boys). Median age at participation was 26.5 months (range: 13.8-156). Twenty-four (75%) had transanal pullthrough, 8(25%) underwent Duhamel procedure. PICSS scored 10(31.3%) as normal, 8(25%) as constipation, 10(31.3%) as incontinent, and 4(12.5%) as mixed. RAIR was present in 12 patients (37.5%). HPZ, maximum ARP, mean ARP were comparable across all PICSS groups without statistically significant differences. Presence of RAIR was not significantly associated with any PICSS groups (p = 0.13).
Conclusion:
Bowel function does not appear to be significantly associated with HRAM findings after definitive pullthrough for HD, but our study is limited by small sample size. RAIR was present in 37.5% patients after pullthrough.
Level Of Evidence:
Level II.
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