Anal endosonography and bowel function in patients undergoing different types of endorectal pull-through procedures for Hirschsprung disease

Journal of Pediatric Surgery
Kjetil Juul StensrudKristin Bjørnland

Abstract

The reasons for fecal incontinence after surgery for Hirschsprung disease (HD) remain unclear. The aim of this study was to examine the anal sphincters by anal endosonography and manometry after transanal endorectal pull-through, with or without laparotomy or laparoscopy, in HD patients. Furthermore, we aimed to correlate these findings to bowel function. Fifty-two HD patients were followed after endorectal pull-through. Anal endosonography and manometry were performed without sedation at the age of 3 to 16 years. Endosonographic internal anal sphincter (IAS) defects were found in 24/50 patients, more frequently after transanal than transabdominal procedures (69 vs. 19%, p=0.001). In a multiple variable logistic regression model, operative approach was the only significant predictor for IAS defects. Anal resting pressure (median 40mm Hg, range 15-120) was not correlated to presence of IAS defects. Daily fecal incontinence occurred more often in patients with IAS defects (54 vs. 25%, p=0.03). Postoperative IAS defects were frequently detected and were associated with daily fecal incontinence. IAS defects occurred more often after solely transanal procedures. We propose that these surgical approaches are compared in a randomized ...Continue Reading

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Citations

Jul 8, 2016·Pediatric Surgery International·J ZimmerP Puri
Apr 14, 2018·Journal of Pediatric Gastroenterology and Nutrition·Malla I NeuvonenMikko P Pakarinen
Oct 16, 2019·Journal of Laparoendoscopic & Advanced Surgical Techniques. Part a·Chiara IacussoPietro Bagolan
Oct 28, 2017·Pediatric Surgery International·Patrick Ho Yu ChungKim Hung Lee
Sep 29, 2017·Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract·Wen-Kai HuangShu-Cheng Zhang
Jun 27, 2020·Orphanet Journal of Rare Diseases·Kristiina KyrklundMikko P Pakarinen
Jun 23, 2020·Journal of Pediatric Surgery·Marianne V FosbyKristin Bjørnland

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