Factors affecting postoperative fecal soiling in Hirschsprung's disease

We retrospectively assessed the factors that may contribute to fecal soiling after surgery for Hirschsprung's disease. Fifty-eight patients underwent surgery for Hirschsprung's disease and returned for follow up. The patients were divided into two groups based on the presence or absence of fecal soiling. The postoperative period, level of bowel pulled through, stool frequency, stool character, presence or absence of anorectal surgical complications, and manometric findings of the two groups were compared. Forty-three patients (40 boys, 3 girls, mean age 9.5 yr) had soiling and 15 (10 boys, 5 girls, mean age 10.2 yr) did not. Patients with soiling had significantly higher rates of anorectal surgical complications (60% vs 7%), abnormal stool character (75% vs 7%), stool frequency greater than three times per day (63% vs 20%), absence of rectoanal inhibitory reflex (33% vs 2%), and narrow anorectal pressure gradient (60% vs 13%) than those without. The results of manometric study suggested that a damaged internal sphincter or irritable neorectum might have contributed to fecal soiling. In conclusion, although anorectal surgical complications might result in both irritable neorectum and damaged internal sphincter, their effect on the neorectum (significantly increased rate of high resting rectal pressure) seemed to outweigh that on the internal sphincter. A competent anal sphincter and a less irritable neorectum after operation may therefore lower the likelihood of fecal soiling.