Clinical and manometric evaluation of postoperative fecal soiling in patients with Hirschsprung's disease.

We examined the usefulness of manometry as an indicator of fecal soiling after surgical correction of Hirschsprung's disease, and attempted to identify measures to alleviate this complication. Sequential clinical and manometric evaluations of postoperative fecal soiling were performed in 35 patients (30 males, 5 females) with Hirschsprung's disease. The resting anal pressure (RAP), resting rectal pressure, and anorectal pressure gradient (ARPG) all decreased significantly from the preoperative values after corrective pull-through surgery. This correlated well with the clinical change from preoperative obstipation to frequent stool passage or soiling postoperatively. A total of 80% of the patients had mild or severe fecal soiling within 4 years after surgery, but only 40% had persistent symptoms thereafter. The manometric profile showed significant elevations in RAP and ARPG 4 years after surgery. Only five patients had positive conversion of rectoanal sphincteric inhibitory reflex (RASIR) after surgery, and the presence of RASIR was not related to continence. Also, there was no difference in the manometric profile between patients with and without RASIR. However, patients without RASIR were prone to suffer from severe diarrhea or soiling on consuming specific foods or catching cold. In conclusion, anorectal manometry can be an objective tool for the evaluation of postoperative fecal soiling in patients with Hirschsprung's disease. The low conversion rate of RASIR combined with hypersensitivity of the bowel in patients with Hirschsprung's disease suggests that some kind of enteric nervous system disorder might exist other than aganglionosis.