Andrea Bischoff1, Jason Frischer2, Jennifer Leslie Knod2, Belinda Dickie3, Marc A Levitt4, Monica Holder2, Lyndsey Jackson2, Alberto Peña5. 1. International Center for Colorectal Care, Children's Hospital Colorado, Aurora, CO, USA. Electronic address: andrea.bischoff@childrenscolorado.org. 2. Colorectal Center for Children, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. 3. Colorectal and Complex Pelvic Malformation Center, Department of Surgery, Boston Children's Hospital, Boston, MA, USA. 4. Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, USA. 5. International Center for Colorectal Care, Children's Hospital Colorado, Aurora, CO, USA.
Abstract
INTRODUCTION: Fecal incontinence after the surgical repair of Hirschsprung disease is a potentially preventable complication that carries a negative impact on patient's quality of life. METHODS: Patients that were previously operated for Hirschsprung disease and presented to our bowel management clinic with the complaint of fecal incontinence were retrospectively reviewed. All patients underwent a rectal examination under anesthesia looking for anatomic explanations for their incontinence. RESULTS: One hundred three patients were identified. 54 patients had a damaged anal canal. 22 patients also had a patulous anus. The operative reports mentioned the pectinate line in 32 patients, in 12 it was not mentioned, and in 10 patients the operative report was not available. All patients with a damaged anal canal suffered from true fecal incontinence; 45 of them are on daily enemas (41 are clean and 4 are still having "accidents"), 7 are not doing bowel management due to noncompliance and 2 patients have a permanent ileostomy. 49 patients did not have a damaged anal canal, 25 of those responded to changes in diet and medication and are having voluntary bowel movements. CONCLUSION: Fecal incontinence may occur after an operation for Hirschsprung disease. When the anal canal is damaged, incontinence is always present, severe, and probably permanent. The preservation of the anal canal may avoid this complication.
INTRODUCTION: Fecal incontinence after the surgical repair of Hirschsprung disease is a potentially preventable complication that carries a negative impact on patient's quality of life. METHODS:Patients that were previously operated for Hirschsprung disease and presented to our bowel management clinic with the complaint of fecal incontinence were retrospectively reviewed. All patients underwent a rectal examination under anesthesia looking for anatomic explanations for their incontinence. RESULTS: One hundred three patients were identified. 54 patients had a damaged anal canal. 22 patients also had a patulous anus. The operative reports mentioned the pectinate line in 32 patients, in 12 it was not mentioned, and in 10 patients the operative report was not available. All patients with a damaged anal canal suffered from true fecal incontinence; 45 of them are on daily enemas (41 are clean and 4 are still having "accidents"), 7 are not doing bowel management due to noncompliance and 2 patients have a permanent ileostomy. 49 patients did not have a damaged anal canal, 25 of those responded to changes in diet and medication and are having voluntary bowel movements. CONCLUSION: Fecal incontinence may occur after an operation for Hirschsprung disease. When the anal canal is damaged, incontinence is always present, severe, and probably permanent. The preservation of the anal canal may avoid this complication.
Authors: M C Vargas; L A Wehrli; A Louiselle; J Ketzer; M L Reppucci; L Juddy-Glossy; V I Alaniz; D T Wilcox; D N Wood; A Peña; L De La Torre; A Bischoff Journal: Pediatr Surg Int Date: 2022-09-21 Impact factor: 2.003
Authors: L Lagares-Tena; L Millán-Paredes; L Lázaro-García; A Navarro-Luna; S Delgado-Rivilla; A Muñoz-Duyos Journal: Tech Coloproctol Date: 2018-01-16 Impact factor: 3.781
Authors: Kristiina Kyrklund; Cornelius E J Sloots; Ivo de Blaauw; Kristin Bjørnland; Udo Rolle; Duccio Cavalieri; Paola Francalanci; Fabio Fusaro; Annette Lemli; Nicole Schwarzer; Francesco Fascetti-Leon; Nikhil Thapar; Lars Søndergaard Johansen; Dominique Berrebi; Jean-Pierre Hugot; Célia Crétolle; Alice S Brooks; Robert M Hofstra; Tomas Wester; Mikko P Pakarinen Journal: Orphanet J Rare Dis Date: 2020-06-25 Impact factor: 4.123