A technique to reconstruct the anal sphincters following iatrogenic stretching related to a pull-through for Hirschsprung disease

Abstract

Soiling and fecal incontinence are troubling complications which can occur after a pull-through for Hirschsprung disease. They can usually be improved with proper medical management, but in some cases are the result of an anatomic defect related to overstretching of the sphincters and/or damage of the anal canal. For such patients the treatment of this true fecal incontinence is limited to a structured bowel management program with ante-or retrograde enemas to achieve social continence. Herein we report two such patients with overstretched sphincters and loss of the dentate line after an initial pull-through and describe a sphincter tightening technique to improve bowel control.

Evaluation and Management of Postsurgical Patient With Hirschsprung Disease Neurogastroenterology & Motility Committee: Position Paper of North American Society of Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN)

“…Rarely patients who have failed the above modalities may be considered for a permanent stoma in order to achieve continence and improve quality of life. In cases of iatrogenic sphincter injury, a new option to perform sphincter reconstruction has been recently published (112).…”

State of the Art Bowel Management for Pediatric Colorectal Problems: Hirschsprung Disease

“…In 2021, a report on sphincter reconstruction for the treatment of fecal incontinence in patients with overstretched sphincters and damaged dentate line during the primary pull-through was proposed. The reconstruction aims to tighten the sphincters around the pull-through to help the patient hold the stool and achieve bowel control [ 47 , 71 ]. At a one-year follow-up in collaboration with gastroenterology motility and colorectal surgery, improvement of the Baylor Continence Scale and bowel control was reported in a small series of patients without neurologic concerns.…”