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Electrode Placement and Continence Outcomes in Pediatric Hirschsprung's Disease: Rectal Versus Surface Stimulation
Fathia Ahmed1, Safi Ahmed2, Hany Elgohary2,3
1Department of Physical Therapy in Pediatrics and Pediatric Surgery, Faculty of Physical Therapy, Merit University, Sohag, Egypt.
Insights
Rectal electrode stimulation, combined with anal sphincter exercises and biofeedback, significantly improves bowel function and quality of life in children with Hirschsprung disease (HD). This multimodal approach offers sustained benefits for pediatric patients post-surgery.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Rehabilitation Medicine
Background:
- Hirschsprung disease (HD) often requires corrective surgery, which can lead to long-term bowel dysfunction and incontinence in pediatric patients.
- Post-surgical management frequently involves anal sphincter (AS) exercises and biofeedback training to improve outcomes.
- The efficacy of different electrical stimulation methods, rectal versus surface electrodes, in conjunction with standard therapies remains an area for investigation.
Purpose of the Study:
- To compare the effectiveness of rectal electrode stimulation versus surface electrode stimulation.
- To evaluate the combined impact of electrical stimulation, AS exercises, and biofeedback on children post-HD surgery.
- To assess improvements in bowel function, continence, and quality of life.
Main Methods:
- A randomized controlled trial involving 67 pediatric patients who had undergone corrective surgery for HD.
- Patients were assigned to either rectal electrode stimulation (n=34) or surface electrode stimulation (n=33) groups.
- Both groups received identical AS exercises and biofeedback protocols, with outcomes measured using PedsQL, BFS, and PICSS at baseline, post-intervention, and follow-up.
Main Results:
- Both stimulation methods, combined with AS exercises and biofeedback, led to significant improvements across all measured outcomes (PedsQL, BFS, PICSS).
- Statistically significant improvements were observed over time, with the most substantial gains from baseline to follow-up, indicating sustained effects.
- Rectal electrode stimulation demonstrated notable efficacy in enhancing bowel function, continence, and quality of life.
Conclusions:
- Electrical stimulation using rectal electrodes, alongside AS exercises and biofeedback, is a highly effective multimodal approach for improving bowel function and quality of life in children with Hirschsprung disease.
- These findings underscore the potential of multimodal rehabilitation strategies in managing post-surgical HD complications.
- Further multicenter studies are recommended to validate these promising results and explore broader applications.
Objective:
To compare the outcome of rectal and surface electrode stimulation, when performed concomitantly with routine anal sphincter (AS) exercises and bio-feedback training, in children who have received corrective surgery to address Hirschsprung disease (HD).
Methods:
Sixty-seven patients (pediatric) who underwent corrective surgery due to HD were randomly assigned to Group A (rectal electrode, n=34) or Group B (surface electrode, n=33). The two groups were given the same protocols of AS and bio-feedback training. The Pediatric Quality of Life Inventory (PedsQL), Bowel Function Score (BFS), Pediatric Incontinence and Constipation Scoring System Scale (PICSS) were measured at baseline, post intervention and follow-up.
Results:
There were significant improvements in both groups over time across all outcomes. PedsQL increased (d=0.42-1.28, η²p up to 0.37), BFS improved notably (d=1.21, η²p=0.35), and PICSS decreased (d up to 1.15, η²p=0.33). The greatest gains occurred from baseline to follow-up, with smaller but significant changes from post-treatment to follow-up, indicating sustained effects.
Conclusion:
Electrical stimulation with rectal electrodes, combined with AS exercises and bio-feedback training, is a major way of improving bowel functioning, continence and quality of life in Hirschsprung child. Such results highlight the promise of multimodal rehabilitation and should be supported by additional multicenter studies.
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