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Related Experiment Videos

Internal sphincterotomy in post-pull-through Hirschsprung's disease

G K Blair1, J J Murphy, G C Fraser

  • 1Division of Paediatric General Surgery, British Columbia Children's Hospital, Vancouver, Canada.

Journal of Pediatric Surgery
|June 1, 1996
PubMed
Summary

Posterior internal sphincterotomy effectively treated severe constipation after pull-through surgery for Hirschsprung's disease in 90% of patients. This intervention resolved megarectum and megacolon, improving bowel evacuation.

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Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Colorectal Surgery

Background:

  • Pull-through operations for Hirschsprung's disease can result in persistent bowel evacuation difficulties.
  • Severe constipation, obstipation, and fecal retention are common post-operative complications.
  • Previous conservative management with laxatives and enemas often proves unsuccessful.

Purpose of the Study:

  • To evaluate the efficacy of full posterior internal sphincterotomy in patients with Hirschsprung's disease who experienced persistent bowel evacuation issues after pull-through surgery.
  • To assess the resolution of megarectum and megacolon following sphincterotomy.

Main Methods:

  • Ten patients with Hirschsprung's disease and post-pull-through constipation underwent full posterior internal sphincterotomy.

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  • Procedures included Soave, Duhamel, and Kimura-Soave techniques.
  • Radiographic and biopsy assessments were performed to confirm megarectum/megacolon and presence of ganglia.

    • Main Results:

    • Nine out of ten patients (90%) achieved good or excellent outcomes after sphincterotomy.
    • Sphincterotomy led to the resolution of megarectum and megacolon in these patients.
    • Three patients required minimal, decreasing doses of senna compound post-operatively.

    Conclusions:

    • Full posterior internal sphincterotomy is a highly effective treatment for refractory constipation and megarectum/megacolon following pull-through surgery for Hirschsprung's disease.
    • This surgical intervention significantly improves bowel evacuation in the majority of affected pediatric patients.
    • One patient with Down's syndrome and a Duhamel pull-through required a stoma, indicating potential specific challenges.