Interest of Anorectal Manometry During Long-term Follow-up of Patients Operated on for Hirschsprung's Disease

Abstract

Background/AimsAlthough many advances in the management of Hirschsprung's disease have recently been achieved, postoperative outcomes of these patients remain difficult in a non-negligible number of cases. Therefore, this study aims at investigating characteristics of anorectal manometry and its relationship with postoperative outcomes during long-term follow-up in Hirschsprung patients. MethodsPatients over 4 years of age operated on for Hirschsprung's disease were interviewed to complete detailed questionnaires on bowel function. The patients who consented to undergo an anorectal manometry during follow-up were enrolled in this study. We investigated their clinical characteristics, manometric findings, and their postoperative bowel function. ResultsNineteen patients out of 53 patients (35.8%) were enrolled, 68.4% who were male. Mean age of patients at manometry was 11.3 ± 6.3 years. Twelve out of 19 patients (63.2%) were incontinent. The mean anal resting pressures of incontinent patients were significantly lower than continent patients (47 ± 12 mmHg versus 63 ± 11 mmHg, P < 0.05, t test). Due to neurological impairment, only 11 patients (57.9%) were able to perform a complete manometry. A dyssynergic defecation was found in 4 patients during strain tests. Maximum tolerated volume of the incontinent patients was significantly lower than that of the continent patients (97 ± 67 mL versus 181 ± 74 mL, P < 0.05, t test). ConclusionAnorectal manometry is an objective method providing useful information that could guide a more adapted management in patients with defecation disorders after Hirschsprung's disease operation.

Diagnosis and management of fecal incontinence in children and adolescents

“…Tran reported that the prevalence of FI and constipation was 22.6% and 13.2%, respectively, in the enrolled 53 children following surgery for HD. The values of resting anal pressure and the maximum tolerated volume in incontinent patients were significantly lower than those in continent patients (36). Similar results were also reported by other researchers (37).…”

Laparoscopic Complete Excision of the Posterior Muscular Cuff: Technique Refinements and Comparison With Stepwise Gradient Muscular Cuff Cutting for Hirschsprung Disease

“…In this study, we found that 19.4% of soiling in the LCEPC procedure was higher than the LSGC procedure, and the anal resting pressure was significantly lower in the LCEPC group. Tran et al ( 23 ) reported that the internal and external anal sphincters contributed to 55.0% and 35.0% of the anal resting pressure, respectively. Therefore, the decreased anal resting sphincter pressure was related to the partial resection of the internal anal sphincter in the LCEPC procedure.…”

Three dimension high‐definition manometry in evaluation of anorectal function in 104 normal infants and children: A clinical study from China

“…Anorectal manometry (ARM) is a noninvasive and repeatable diagnostic test for the quantitative evaluation of anorectal function 1 . It has been widely used in the diagnosis of Hirschsprung's disease (HD), 2,3 functional constipation, 4‐6 and the evaluation of patients after anorectal surgery 7‐9 . It is well known that there is rapid body growth between infancy and childhood; however, neither the physiological or functional development of the anorectal canal during this period is well understood, and the reference values for pediatric manometry are remain to be validated.…”

“…1 It has been widely used in the diagnosis of Hirschsprung's disease (HD), 2,3 functional constipation, 4-6 and the evaluation of patients after anorectal surgery. [7][8][9] It is well known that there is rapid body growth between infancy and childhood; however, neither the physiological or functional development of the anorectal canal during this period is well understood, and the reference values for pediatric manometry are remain to be validated. Previous research 10,11 studied the relationship between anal function and age, but no consistent…”