Anal canal and sphincter function in children with Hirschsprung disease after definitive surgery

Tan, Wei Sheng and Hasan, Zulfitri Md and Sanmugam, Anand and Singaravel, Srihari and Abdullah, Mohd Yusof and Nah, Shireen Anne (2023) Anal canal and sphincter function in children with Hirschsprung disease after definitive surgery. Journal of Pediatric Surgery, 58 (2). pp. 241-245. ISSN 0022-3468, DOI

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Introduction: Anorectal manometry may be useful to objectively evaluate anorectal function following definitive pullthrough for Hirschsprung Disease (HD) but there is little published data. Our study aims to investigate anorectal manometry findings and their association with bowel function. Methodology: This was a prospective observational study. Convenience sampling method was used to recruit all HD patients who had definitive pullthrough from January 2019 to December2020 in our institution. High-resolution anorectal manometry (HRAM) was used to record anal resting pressure (ARP), length of high-pressure zone (HPZ), and presence/absence of recto-anal inhibitory reflex (RAIR). The Paediatric Incontinence/Constipation Scoring System (PICSS) was scored for all participants. PICSS is a validated questionnaire with scores mapped to an age-specific normogram to denote constipation, incontinence, and their combinations. Non-parametric and chi-square tests at significance p < 0.05 were conducted to examine the relationship between PICSS categories and manometry findings. Ethical approval was obtained. Results: There were 32 participants (30 boys). Median age at participation was 26.5 months (range: 13.8- 156). Twenty-four (75%) had transanal pullthrough, 8(25%) underwent Duhamel procedure. PICSS scored 10(31.3%) as normal, 8(25%) as constipation, 10(31.3%) as incontinent, and 4(12.5%) as mixed. RAIR was present in 12 patients (37.5%). HPZ, maximum ARP, mean ARP were comparable across all PICSS groups without statistically significant differences. Presence of RAIR was not significantly associated with any PICSS groups ( p = 0.13). Conclusion: Bowel function does not appear to be significantly associated with HRAM findings after definitive pullthrough for HD, but our study is limited by small sample size. RAIR was present in 37.5% patients after pullthrough. Level of Evidence: Level II

Item Type: Article
Uncontrolled Keywords: Hirschsprung disease; Anorectal manometry; Bowel function
Subjects: R Medicine > RD Surgery
R Medicine > RJ Pediatrics
Divisions: Faculty of Medicine > Surgery Department
Depositing User: Ms Zaharah Ramly
Date Deposited: 05 Jul 2023 06:44
Last Modified: 05 Jul 2023 06:44

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