The anal canal is the fine line between “fecal incontinence and colitis” after a pull-through for Hirschsprung disease

Torre, Luís de la; Cogley, Kimberly; Santos, K. Paulino dos; Morales, Otto; Calisto, Juan L.

doi:10.1016/j.jpedsurg.2017.08.040

Cited by 26 publications

(7 citation statements)

References 26 publications

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“…The presence of scar tissue within the IAS and EAS on anal endosonography has been associated impaired sphincter muscle function (low intra-anal pressures and squeeze pressures on ARM) (96) and with clinical symptoms of FI in children (97). The secondary aim of the rectal exam under anesthesia is to evaluate the anal canal with specific attention to the location of the anastomosis (ie, proximity to the dentate line, anoderm, skin) and the integrity of the dentate line (11,32,93,94,98). Damage to the dentate line may disrupt sensation and potentially increase risk of FI given the poor ability of the patient to discern between gas, liquid, or solid stool (93,94,98) (Fig.…”

Section: Overview Of Assessment Of a Symptomatic Postsurgical Patientmentioning

confidence: 99%

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)

Ambartsumyan

Patel

Kapavarapu

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Children with Hirschsprung disease have postoperative long-term sequelae in defecation that contribute to morbidity and mortality and significantly impact their quality of life. Pediatric patients experience ongoing long-term defecation concerns, which can include fecal incontinence (FI) and postoperative obstructive symptoms, such as constipation and Hirschsprung-associated enterocolitis. The American Pediatric Surgical Association has developed guidelines for management of these postoperative obstructive symptoms and FI. However, the evaluation and management of patients with postoperative defecation problems varies among different pediatric gastroenterology centers. This position paper from the Neurogastroenterology & Motility Committee of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition reviews the current evidence and provides suggestions for the evaluation and management of postoperative patients with Hirschsprung disease who present with persistent defecation problems.

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Section: Overview Of Assessment Of a Symptomatic Postsurgical Patientmentioning

confidence: 99%

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)

Ambartsumyan

Patel

Kapavarapu

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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“…[28] The soiling due to damage of the anal canal is a "preventable, irreparable, and irreversible complication". [36] To avoid such a devastating complication, Torre-Mondragon et al recommended that one should protect the entire anal canal and start the incision 2 cm above the dentate zone to preserve the highly sensitive area, which is essential for fecal continence. [36] They further recommended dilating the anus before placement of the lone star retractor® with a Hagar dilator up to 2 numbers higher than the number that corresponds to the age of the patient, to relax the sphincter muscle.…”

Section: Bowel Obstruction In Infancy Is Often Due Tomentioning

confidence: 99%

“…[36] To avoid such a devastating complication, Torre-Mondragon et al recommended that one should protect the entire anal canal and start the incision 2 cm above the dentate zone to preserve the highly sensitive area, which is essential for fecal continence. [36] They further recommended dilating the anus before placement of the lone star retractor® with a Hagar dilator up to 2 numbers higher than the number that corresponds to the age of the patient, to relax the sphincter muscle. [36] Applying traction sutures on the proximal end of the mucosa further helps dissection without aggressive retraction on the sphincter mechanism.…”

Section: Bowel Obstruction In Infancy Is Often Due Tomentioning

confidence: 99%

“…[36] They further recommended dilating the anus before placement of the lone star retractor® with a Hagar dilator up to 2 numbers higher than the number that corresponds to the age of the patient, to relax the sphincter muscle. [36] Applying traction sutures on the proximal end of the mucosa further helps dissection without aggressive retraction on the sphincter mechanism. [15] In a review of fecal incontinence after surgical repair of Hirschsprung's disease in 2017, Bischoff et al concluded that a meticulous surgical technique may further avoid this complication.…”

Section: Bowel Obstruction In Infancy Is Often Due Tomentioning

confidence: 99%

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A comparison between primary endorectal pull-through and staged procedures for patients with Hirschsprung’s disease

Zbaida¹,

Vos²,

Sidler³

2021

J Neonatal Surg

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Background: Primary endorectal pull-through is becoming a standard of care across the globe. This study was done to compare the outcome of patients with Hirschsprung’s disease (HD) who underwent primary endorectal pull-through with patients who were treated with a staged approach. Methods: A retrospective data review was done of all patients diagnosed with Hirschsprung’s disease (HD) at Tygerberg Children’s Hospital, a tertiary hospital in Cape Town, during an 11-year period (2007 – 2018). The patients were divided into 2 groups: the primary Endorectal pull-through (ERP) group and the staged group and the two groups were compared. Results: Eighty patients with histologically confirmed Hirschsprung’s disease (HD) were seen at our institution during the study period (2007 – 2018). Four patients did not meet the inclusion criteria and were excluded. Of the remaining seventy-six who were included, forty-six patients (60.5%) had a primary endorectal-pull through (Primary group) and thirty patients (39.5%) had staged procedures (Staged group) with a stoma before the final ERP. The peri-operative complications were subdivided into major and minor complications. Minor perioperative complications in the primary group were less (13%) compared to the staged group (33%) with a p-value of 0.017, making the difference statistically significant. Anastomotic strictures were the most common complication in both groups with abdominal wound infection being more common in the staged group. The late complications were similar in both groups with a p-value of 0.43. Constipation was the most common complication in both groups, followed by soiling. Conclusion: The two groups had a similar outcome without statistically significant differences. We can safely conclude that the primary endorectal pull-through for HD is at least as safe as the staged approach in Sub- Saharan Africa. With this technique, we avoid a stoma and the necessity for two surgical procedures with added potential complications.

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“…Good continence with this type of surgery is difficult to achieve. [ 4 ] They had not assessed the nocturnal continence/soiling in these children, which could affect Quality of Life to a great extent. The response at follow-up was only 45% (69/152) and these patients might be a select happier group; the good result was thus skewed by inherent selection bias.…”

mentioning

confidence: 99%

Critical review of the original article “Modified duhamel two-stage procedure for hirschsprung's disease: Further modification for improved outcome” by Nitin J. Peters et al. in september–october, 2020 issue of JIAPS issue

Biswas¹

2021

J Indian Assoc Pediatr Surg

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The anal canal is the fine line between “fecal incontinence and colitis” after a pull-through for Hirschsprung disease

Cited by 26 publications

References 26 publications

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)

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)

A comparison between primary endorectal pull-through and staged procedures for patients with Hirschsprung’s disease

Critical review of the original article “Modified duhamel two-stage procedure for hirschsprung's disease: Further modification for improved outcome” by Nitin J. Peters et al. in september–october, 2020 issue of JIAPS issue

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