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Postoperative sequential anorectal manometric study of children with Hirschsprung's disease
Insights
Children with Hirschsprung's disease show abnormal anal canal pressure responses to rectal distension. Post-surgery, the reappearance of the rectosphincteric reflex correlates with improved fecal continence.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Colorectal Surgery
Background:
- Hirschsprung's disease is a congenital condition characterized by the absence of ganglion cells in the distal bowel.
- Abnormalities in the rectosphincteric reflex and anorectal pressures are key features of Hirschsprung's disease.
- Surgical correction, typically coloproctectomy with anastomosis, aims to restore normal bowel function.
Purpose of the Study:
- To investigate the intraluminal pressure changes in the anal canal during rectal distension in children with Hirschsprung's disease compared to healthy controls.
- To evaluate the recovery of the rectosphincteric reflex and its correlation with fecal continence after coloproctectomy and Z-shaped anastomosis.
- To determine if the length of aganglionosis impacts these physiological responses.
Main Methods:
- Rectal distension using a balloon catheter to measure intraluminal pressure in the anal canal.
- Comparison of pressure responses between children with Hirschsprung's disease and normal children.
- Assessment of the rectosphincteric reflex and fecal continence at 1 and 2 months post-operatively following coloproctectomy and Z-shaped anastomosis.
Main Results:
- In normal children, rectal distension caused a drop in anal canal pressure, whereas in children with Hirschsprung's disease, pressure rose.
- The average resting anorectal pressure was higher in children with Hirschsprung's disease than in controls.
- One month after surgery, the rectosphincteric reflex was absent in most patients, but reappeared in 77% by two months.
- The presence of the rectosphincteric reflex post-surgery was strongly associated with excellent fecal continence.
Conclusions:
- Hirschsprung's disease is associated with distinct alterations in anorectal pressures and reflex responses.
- The recovery of the rectosphincteric reflex following surgical correction is a critical factor for achieving good fecal continence.
- Surgical outcomes in Hirschsprung's disease can be monitored by assessing the rectosphincteric reflex and continence status.
Abstract:
When the rectum was distended artificially by a balloon, intraluminal pressure in the anal canal dropped in 30 normal children, but rose in 22 children with Hirschsprung's disease. This was independent of the length of aganglionosis. The average resting pressure in the anorectum in Hirschsprung's disease was higher than that of normal children. In patients who underwent coloproctectomy and Z-shaped anastomosis for Hirschsprung's disease, the rectosphincteric reflex was absent 1 mo after operation. Two months after surgery, however, the rectosphincteric reflex appeared in 77% of the patients. The patients who developed a rectosphincteric reflex had excellent continence, while some of those who did not show the reflex had incomplete continence or mild constipation.