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Stooling patterns and colonic motility after transanal one-stage pull-through operation for Hirschsprung's disease in children.
J Pediatr Surg. 2005 Nov; 40(11):1766-72.JP

Abstract

BACKGROUND

The transanal one-stage endorectal pull-through operation for Hirschsprung's disease is relatively new and makes assessment of the functional outcome and colonic motility difficult. The aim of this study was to evaluate the stooling patterns and colonic motility after a one-stage transanal pull-through operation for Hirschsprung's disease in children.

METHODS

Twenty-two children who underwent a one-stage transanal pull-through operation for Hirschsprung's disease were followed up for at least 6 months. The children (17 boys and 5 girls) were from 12 months to 13 years of age (mean age, 4 years). All patients had an aganglionic segment confined to the rectosigmoid area (confirmed by preoperative barium enema and postoperative histology). Clinical outcome was assessed by interviews and questionnaires, and children were divided into symptomatic and nonsymptomatic groups. Contrast barium enema and defecography and determination of total and segmental colonic transit time (using radio-opaque markers) were performed on all 22 children.

RESULTS

The stooling patterns were considered satisfactory in 17 children. Of all the children, the mean stool times were 1 to 2 per day and only 2 were 8 to 10 per day; postoperative soiling was found in 4, constipation was observed in 2, and Hirschsprung-associated enterocolitis in 1. There was no incontinence, cuff infection, anastomotic leak, or mortality noted. Barium enema showed that the dilated and spastic colonic segment disappeared in all 22 children. The dilated sigmoid loops decreased in 17 (2 symptomatic, 15 nonsymptomatic) and disappeared in 5 (4 symptomatic, 1 nonsymptomatic). There was a significant difference between the decreasing and disappearing loop group in regard to stooling disorders (P < .05). Postoperative defecography showed that the anorectal angle of all children was open, fixed, and significantly larger than that of the preoperative and control groups (123.3 degrees +/- 15.1 degrees vs 84.7 degrees +/- 8.3 degrees vs 79.0 degrees +/- 11.6 degrees, P < .01) and larger in the symptomatic group when compared with the nonsymptomatic group (135.6 degrees +/- 15.9 degrees vs 111.0 degrees +/- 14.3 degrees, P < .05). Postoperatively, the total gastrointestinal transit time, left colonic transit time, and rectosigmoid colonic transit time of all the children were shorter than preoperatively (26.8 +/- 8.2 vs >188 hours, P < .01; 6.3 +/- 4.1 vs >60 hours, P < .01; 11.8 +/- 4.4 vs >120 hours, P < .01) and similar to controls. The total gastrointestinal transit time and rectosigmoid colonic transit time of the symptomatic group were significantly shorter than the nonsymptomatic group (25.2 +/- 5.6 vs 28.1 +/- 10.1 hours, P < .05; 12.2 +/- 6.7 vs 9.8 +/- 4.0 hours, P < .05).

CONCLUSIONS

The stooling pattern and colonic motility are satisfactory in most children after the one-stage transanal pull-through operation for Hirschsprung's disease. Normalization of colon appearance and total and segmental colonic transit time are signs of recovery of colonic motility. Stooling disorders were noted in a few cases and may be related to decrease or disappearance of the sigmoid loop, dysfunction of the "neorectosigmoid", an open and fixed anorectal angle, and ischemia of the pull-through segment.

Authors+Show Affiliations

Department of Pediatric Surgery, The Second Affiliated Hospital, China Medical University, Shenyang 110004, PR China.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article

Language

eng

PubMed ID

16291167

Citation

Zhang, Shu Cheng, et al. "Stooling Patterns and Colonic Motility After Transanal One-stage Pull-through Operation for Hirschsprung's Disease in Children." Journal of Pediatric Surgery, vol. 40, no. 11, 2005, pp. 1766-72.
Zhang SC, Bai YZ, Wang W, et al. Stooling patterns and colonic motility after transanal one-stage pull-through operation for Hirschsprung's disease in children. J Pediatr Surg. 2005;40(11):1766-72.
Zhang, S. C., Bai, Y. Z., Wang, W., & Wang, W. L. (2005). Stooling patterns and colonic motility after transanal one-stage pull-through operation for Hirschsprung's disease in children. Journal of Pediatric Surgery, 40(11), 1766-72.
Zhang SC, et al. Stooling Patterns and Colonic Motility After Transanal One-stage Pull-through Operation for Hirschsprung's Disease in Children. J Pediatr Surg. 2005;40(11):1766-72. PubMed PMID: 16291167.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Stooling patterns and colonic motility after transanal one-stage pull-through operation for Hirschsprung's disease in children. AU - Zhang,Shu Cheng, AU - Bai,Yu Zuo, AU - Wang,Wei, AU - Wang,Wei Lin, PY - 2005/11/18/pubmed PY - 2006/7/27/medline PY - 2005/11/18/entrez SP - 1766 EP - 72 JF - Journal of pediatric surgery JO - J Pediatr Surg VL - 40 IS - 11 N2 - BACKGROUND: The transanal one-stage endorectal pull-through operation for Hirschsprung's disease is relatively new and makes assessment of the functional outcome and colonic motility difficult. The aim of this study was to evaluate the stooling patterns and colonic motility after a one-stage transanal pull-through operation for Hirschsprung's disease in children. METHODS: Twenty-two children who underwent a one-stage transanal pull-through operation for Hirschsprung's disease were followed up for at least 6 months. The children (17 boys and 5 girls) were from 12 months to 13 years of age (mean age, 4 years). All patients had an aganglionic segment confined to the rectosigmoid area (confirmed by preoperative barium enema and postoperative histology). Clinical outcome was assessed by interviews and questionnaires, and children were divided into symptomatic and nonsymptomatic groups. Contrast barium enema and defecography and determination of total and segmental colonic transit time (using radio-opaque markers) were performed on all 22 children. RESULTS: The stooling patterns were considered satisfactory in 17 children. Of all the children, the mean stool times were 1 to 2 per day and only 2 were 8 to 10 per day; postoperative soiling was found in 4, constipation was observed in 2, and Hirschsprung-associated enterocolitis in 1. There was no incontinence, cuff infection, anastomotic leak, or mortality noted. Barium enema showed that the dilated and spastic colonic segment disappeared in all 22 children. The dilated sigmoid loops decreased in 17 (2 symptomatic, 15 nonsymptomatic) and disappeared in 5 (4 symptomatic, 1 nonsymptomatic). There was a significant difference between the decreasing and disappearing loop group in regard to stooling disorders (P < .05). Postoperative defecography showed that the anorectal angle of all children was open, fixed, and significantly larger than that of the preoperative and control groups (123.3 degrees +/- 15.1 degrees vs 84.7 degrees +/- 8.3 degrees vs 79.0 degrees +/- 11.6 degrees, P < .01) and larger in the symptomatic group when compared with the nonsymptomatic group (135.6 degrees +/- 15.9 degrees vs 111.0 degrees +/- 14.3 degrees, P < .05). Postoperatively, the total gastrointestinal transit time, left colonic transit time, and rectosigmoid colonic transit time of all the children were shorter than preoperatively (26.8 +/- 8.2 vs >188 hours, P < .01; 6.3 +/- 4.1 vs >60 hours, P < .01; 11.8 +/- 4.4 vs >120 hours, P < .01) and similar to controls. The total gastrointestinal transit time and rectosigmoid colonic transit time of the symptomatic group were significantly shorter than the nonsymptomatic group (25.2 +/- 5.6 vs 28.1 +/- 10.1 hours, P < .05; 12.2 +/- 6.7 vs 9.8 +/- 4.0 hours, P < .05). CONCLUSIONS: The stooling pattern and colonic motility are satisfactory in most children after the one-stage transanal pull-through operation for Hirschsprung's disease. Normalization of colon appearance and total and segmental colonic transit time are signs of recovery of colonic motility. Stooling disorders were noted in a few cases and may be related to decrease or disappearance of the sigmoid loop, dysfunction of the "neorectosigmoid", an open and fixed anorectal angle, and ischemia of the pull-through segment. SN - 1531-5037 UR - https://www.unboundmedicine.com/medline/citation/16291167/Stooling_patterns_and_colonic_motility_after_transanal_one_stage_pull_through_operation_for_Hirschsprung's_disease_in_children_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-3468(05)00623-8 DB - PRIME DP - Unbound Medicine ER -