J Neurogastroenterol Motil.  2018 Jan;24(1):70-78. 10.5056/jnm17019.

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

• Tran VQ
• Mahler T
• Bontems P
• Truong DQ
• Robert A
• Goyens P
• Steyaert H

• KMID: 2417274
• DOI: http://doi.org/10.5056/jnm17019

Abstract

BACKGROUND/AIMS
Although 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.
METHODS
Patients 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.
RESULTS
Nineteen 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).
CONCLUSION
Anorectal 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.

Keyword

Defecation; Follow-up studies; Hirschsprung disease; Manometry; Postoperative period

MeSH Terms

Defecation
Follow-Up Studies*
Hirschsprung Disease*
Humans
Male
Manometry*
Methods
Postoperative Period