Lateral sphincteromyotomy in patients with outlet obstruction after surgery for Hirschsprung's disease and short-segment disease.

The results of lateral sphincteromyotomy (LSM) including the external sphincter in patients with severe outlet obstruction (OO) and constipation refractory to medical treatment after surgery for Hirschsprung's disease (HD) or with short-segment disease were evaluated. The parents filled out a detailed questionnaire on the child's bowel habits prior to surgery and at follow-up 2-26 months after surgery. The postoperative questionnaire included a 10-grade visual analog scale (VAS) indicating the general effect of LSM on the child's bowel habits: grade 1 represented no change at all and 10 represented an excellent result with normal bowel habits. 15 (65%) of the 23 patients had a VAS score of 7 or more, and 7 were reported to have normal bowel habits. Patients with a previous Soave operation did better compared to patients with short-segment disease (SSD). In 2 patients (Soave's operation) with scores of 1 and 2, respectively, a sigmoidostomy was performed 4 and 6 months after the LSM. High-dose laxatives and/or enemas have been used in the 5 patients with scores of 3-5. One patient developed a perianal abscess and one experienced minor soiling. LSM including the whole sphincter complex thus gave significant symptomatic relief in two-thirds of the patients. However, the long-term results are still pending.