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[Bowel control after surgery for Hirschsprung's disease]
Insights
Bowel control issues in children with Hirschsprung
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Colorectal Surgery
Context:
- Hirschsprung's disease is a congenital condition affecting the large intestine.
- Surgical correction often involves intestinal anastomosis.
- Long-term functional outcomes, particularly bowel control, require ongoing assessment.
Purpose:
- To evaluate the long-term efficacy of Ikeda's Z-shaped anastomosis for Hirschsprung's disease.
- To assess the prevalence and evolution of bowel control disorders post-surgery.
- To correlate clinical findings with radiological and manometric data.
Summary:
- A study of 66 children following Ikeda's Z-shaped anastomosis for Hirschsprung's disease revealed initial bowel control issues.
- Constipation, incontinence, and soiling were observed, but these symptoms generally improved with age.
- Radiological findings (megarectum, wide anal canal) and anal canal pressures correlated with specific bowel control issues.
Impact:
- Provides insights into the functional outcomes of a specific surgical technique for Hirschsprung's disease.
- Highlights the importance of age-related improvement in bowel control.
- Informs treatment strategies for persistent constipation and incontinence, including laxatives, enemas, and biofeedback.
Abstract:
Bowel control was studied in 66 children operated by Ikeda's Z-shaped anastomosis for Hirschsprung's disease. At the age of 2 or 3 years, mild constipation was recognized in 16% of the children, incontinence in 12% and soiling in 28%. However, these disorders reduced as the patients grew up and finally over 7 years, constipation was seen in 8% of the patients, incontinence in 8% and soiling in 19%. According to barium enema, megarectum was seen in all constipated children but one, though slight megarectum was sometimes seen even in normal or incontinent children. Frequently, anal canal was wide and leakage of barium through the anus was seen in incontinent or soiling children. Anal canal pressure was high in constipated group, low in soiling group and the lowest in incontinent group. The appearance rate of rhythmical wave of anal canal and recto-anal reflex was the same among all groups. Our treatment of the constipation and incontinence is daily bowel movement using laxative, suppository or enema. For the incontinent patients without rectal sensation, biofeedback method or electrical stimulation is applied.