Long-term Evaluation of Modified Lateral Anorectal Myomectomy for Low-Segment Hirschsprung Disease

Shehata, Sherif M.; el-Banna, I; Gaber, Ahmed; El-Samongy, Ahmed M.; Attia, Mohamed A.

doi:10.1001/archsurg.133.3.269

Cited by 4 publications

(4 citation statements)

References 17 publications

(17 reference statements)

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“…Anorectal myectomy is a excellent diagnostic and therapeutic procedure for different cause of refractory chronic constipation (7,16,18) . Fecal consistency, feces diameter, number of bowel movements, and straining for defecation were improved after posterior myectomy.…”

Section: Resultsmentioning

confidence: 99%

Results of Posterior Myectomy for the Treatment of Children With Chronic Constipation

Peyvasteh

Askarpour

Talaiezadeh

et al. 2015

Arq. Gastroenterol.

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-Background and Objectives -The aim of this study was to evaluate the result of posterior myectomy in children with chronic constipation who underwent to this surgery. Methods -Forty eight children with chronic constipation who did not respond to diet, laxative, or enema were included. Children with abnormal barium enema showing transitional zone were excluded. Children with documented metabolic disease diabetes, and hypothyroidism were also excluded. All patients underwent posterior myectomy. Children were followed during 1 year after surgery regarding frequency of fecal evacuation, fecal consistency, straining during defecation, and diameter of feces. Data was analyzed using SPSS version 13.0 (Chicago, IL, USA). Results -Of 48 cases that underwent surgery, 21 were male and 27 were female. Age range was 1.5 to 11 years old. Mean duration of constipation before surgery was 22.79±17.08 (range 6-48 months). Mean duration of medical treatment was 14.90±10.31 (range= 6-48 months). Fecal consistency, feces diameter, number of bowel movements and straining during defecation were compared before and after surgery. The results were statistically significant (P<0.001). Of all cases, 52% continued treatment of constipation after surgery for 1 year. Ganglion cells were absent in 32 cases. Ganglion cells were present in seven children. Proximal ganglion cell was found in nine cases Treatment response was not different between cases according to status of ganglion cell in biopsy. Conclusion -Fecal consistency, feces diameter, number of bowel movements, and straining for defecation were improved after posterior myectomy. Another study with more sample is required for better evaluation of treatment. HEADINGS -Anal canal. Constipation. Fecal incontinence. Hirschsprung disease.Declared conflict of interest of all authors: none Disclosure of funding: no funding received

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Section: Resultsmentioning

confidence: 99%

Results of Posterior Myectomy for the Treatment of Children With Chronic Constipation

Peyvasteh

Askarpour

Talaiezadeh

et al. 2015

Arq. Gastroenterol.

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“…Several techniques have been described for anorectal myomectomy[10111213] but all depend on excision of a longitudinal strip of muscle for a variable distance with variable approaches. This study was designed to evaluate the role of posterior myomectomy in children with refractory constipation for the diagnosis and as a modality of treatment.…”

Section: Discussionmentioning

confidence: 99%

Role of ano rectal myomectomy in children with chronic refractory constipation

Redkar

Raj

Bangar

et al. 2018

Afr J Paediatr Surg

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Background:Chronic refractory constipation (CRC) is an uncommon type of constipation. These children have persistent symptoms even after treatment with high dose laxatives, which may cause abdominal distension, vomiting, cramping and bloating. We conducted this study to assess the diagnostic and therapeutic role of anorectal myomectomy in children with CRC.Materials and Methods:This study includes 107 patients who fit the criteria of CRC. Complete bowel preparation with polyethylene glycol solution, enemas and antibiotics was carried out before surgery in all patients. The anorectal myomectomy was carried out under general anaesthesia with the patient in the high lithotomy position. The patients were followed up from 6 months to 13 years postoperatively. The success of myomectomy was based on the daily and complete passage of stools without the need for medication or enemas.Results:A total of 99 patients were included in the study, of which, 86 (86.86%) patients showed a good response to anorectal myomectomy. Of these, 32 patients had normal histology, 14 had histology suggestive of Hirschsprung's disease, 8 had hypoganglionosis, 10 had ultra-short segment Hirschsprung's disease and 22 had hypertrophic nerves with immature ganglia. Poor response was seen in 13 (13.13%) patients of whom 5 had normal histology, 5 had Hirschsprung's disease, 2 had hypoganglionosis and 1 had ultra-short segment Hirschsprung's disease.Conclusion:Anorectal myomectomy is an effective and technically simple procedure in selected patients with CRC for both diagnostic and therapeutic purposes.

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“…HSCR was independently confirmed clinically and histopathologically by respective experts (V.B., a pediatric gastroenterologist; S.B., a gastrointestinal pathologist). Treatment of ultrashort-segment HSCR with surgical myotomy/myectomy has demonstrated good long-term outcomes and can be the procedure of choice for older children [4,5]. Per-rectal endoscopic myotomy (PREM) eliminates the limitation of surgical myotomy length.…”

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confidence: 99%

“…Treatment of ultrashort-segment HSCR with surgical myotomy/myectomy has demonstrated good long-term outcomes and can be the procedure of choice for older children 4 5 . Per-rectal endoscopic myotomy (PREM) eliminates the limitation of surgical myotomy length.…”

mentioning

confidence: 99%