Postoperative functional and manometric evaluation of patients with Hirschsprung's disease

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

“…However, there are few reports about anorectal manometry during follow-up of children operated on for HD, and its role still seems controversial in terms of the uses of different anorectal manometry systems (conventional versus high-resolution anorectal manometry [HRAM]), lack of normal value, particularly the reference value of HRAM in HD patients. 9,10,14,15 Therefore, this study aimed at investigating the anorectal manometry findings in our patients after operation for HD while considering their longterm bowel function. Regarding our long-term outcome survey, we report findings similar to those described in the literature, that is, defecation disorders remain problematic issues and challenges in a high percentage of the patients even until adulthood, significantly altering their quality of life, especially in cases with fecal incontinence.…”

“…Normally this reflex is absent in HD patients and, in the literature, most authors reported no RAIR in anorectal manometry during follow-up of the patients operated on for HD. 10 In contrast, Mishalany et al 9 and Moore et al 11 reported RAIR reappearance in 10.0% and 13.6% of the operated patients for HD, respectively. Recently, Gad El-Hak et al 25 reported RAIR becoming intact in 11.5% of the HD patients 4 years after operation as well as their improvement in rectoanal sensation.…”

“…25 However, re-establishment of RAIR was not clinically correlated with any positive long-term outcome in our series as well as in the other studies. 9 Of course, a RAIR re-establishment due to technical issues should be always considered. 18 …”

“…It has been suggested that anorectal manometry could help objectify and distinguish between functional disorders and acquired troubles. [9][10][11][12][13] Otherwise little is known about anorectal manometry in patients after surgery for HD. 9,10,14,15 Therefore, this study aims at investigating anorectal manometry findings of patients operated on for HD and the relationship with their outcomes.…”

Hirschsprung’s disease—A complicated therapeutic problem: Some thoughts and solutions based on data and personal experience over 56 years

“…9 Langer and Bernbaum 10 have shown that sphincter injection with botulinum toxin produces long-term relaxation. Local application of nitroglycerin ointment also has been shown to reduce sphincter resistances.…”