Persistent obstructive symptoms after surgery for Hirschsprung’s disease: Development of a diagnostic and therapeutic algorithm

Langer, Jacob C.

doi:10.1016/j.jpedsurg.2004.06.008

Cited by 113 publications

(73 citation statements)

References 22 publications

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“…This could lead to rectal stenosis and be the reason for postoperative obstructive symptoms accompanied by possible soiling or incontinence. 33 For that reason we advocate the use of laparoscopic assistance, instead of open abdominal approach, in order to adequately dissect the colonic mesentery as well as minimize injury during perineal and anorectal dissection and avoiding eventual twist during lowering of the colon. 34 To date, this is used routinely in our institution, as well as in many other centers worldwide.…”

Section: Sensation Testmentioning

confidence: 99%

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

Tran

Mahler

Bontems

et al. 2018

J Neurogastroenterol Motil

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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.

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Section: Sensation Testmentioning

confidence: 99%

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

Tran

Mahler

Bontems

et al. 2018

J Neurogastroenterol Motil

View full text Add to dashboard Cite

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“…A study by Langer reported that 14 patients with internal sphincter achalasia causing bowel obstruction saw significant improvement in their symptoms following treatment with the botulinum toxin injection (BTI). Out of the 14, four had prolonged improvement after one injection, while nine continued to have recurrent symptoms, requiring one to four injections [1]. It was difficult to predict which patients would profit from BTI [9].…”

Section: Discussionmentioning

confidence: 99%

“…These interventions depend on the presumed underlying cause. Various causes responsible for recurrent enterocolitis (RE) are: 1) stricture or stenosis of the anal canal following a pull-through operation; 2) aganglionic pullthrough bowel; 3) pull-through of the transition zone; 4) a motility disorder of the bowel above the pull-though area, which some believe to be secondary to neuronal intestinal dysplasia; and 5) problems particular to the anal canal in Hirschsprung's disease [1]. Problems particular to the anal canal are only considered once the other main causes have been ruled out.…”

Section: Introductionmentioning

confidence: 99%

“…Problems particular to the anal canal can be due to internal sphincter hypertonicity with a non-relaxing sphincter [1] or from a cuff around the pull-through bowel [2]. There are several studies on the role of Botox in the treatment of internal sphincter hypertonicity, including the use of multiple injections up to a maximum of four times [3].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Management of Recurrent Enterocolitis Following Soave’s Pull-Through in a Child With Hirschsprung’s Disease: Value of Botox Injections

Chauhan¹,

Moghul²,

Singh³

2017

J Med Cases

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Recurrent enterocolitis (RE) is a common problem following Soave's pull-through for Hirschsprung's disease. The main cause of this is outlet obstruction. This can be anatomical (stricture, stenosis, and twist of bowel) or histological (aganglionic or transition zone pull through). Outlet obstruction leading to RE can be from two factors that are specific to Soave's pull through: hypertonicity of the internal anal sphincter or residual cuff. A residual cuff can be managed through excision of the cuff, although this is a major surgical undertaking. We report a successful use of Botox in a child with RE secondary to residual cuff following primary laparoscopic Soave's operation. A Botox injection was administered under general anesthesia at five separate sittings. This case demonstrates that repeated Botox injections can be a valuable alternative to colostomy, excision of residual cuff or a redo pull-through when a cuff is thought to be responsible for RE.

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“…In children who undergo surgery, systematic evaluation and the use of a structured and tailored approach to successfully treat persistent incontinence or soiling is recommended. [11][12][13] No studies covered the subtheme of toilet training specific to HD. Some authors suggest botox injections to relax the sphincter muscle and promote defecation.…”

Section: Bowel Managementmentioning

confidence: 99%

Identifying Information Needs for Hirschsprung Disease Through Caregiver Involvement via Social Media: A Prioritization Study and Literature Review (Preprint)

Wittmeier¹,

Hobbs-Murison²,

Holland³

et al. 2018

Preprint

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Persistent obstructive symptoms after surgery for Hirschsprung’s disease: Development of a diagnostic and therapeutic algorithm

Cited by 113 publications

References 22 publications

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

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

Management of Recurrent Enterocolitis Following Soave’s Pull-Through in a Child With Hirschsprung’s Disease: Value of Botox Injections

Identifying Information Needs for Hirschsprung Disease Through Caregiver Involvement via Social Media: A Prioritization Study and Literature Review (Preprint)

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