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Functional outcome after Swenson's operation for Hirshsprung's disease.
Saudi J Gastroenterol. 2010 Jan-Mar; 16(1):30-4.SJ

Abstract

BACKGROUND/AIM

Hirschsprung's disease (HD) is one of the most common causes resulting in lower intestinal obstruction in children with atypical clinical symptoms and inconspicuous morphological findings by barium enema X-ray. Recently, this situation has been largely ameliorated by improvement of instrument for measurement of anorectal pressure. By now, anorectal manometry has been regarded as a routine means for functional assessment and diagnosis of HD. It is accurate in nearly all cases of HD with characteristic absence of rectoanal inhibitory reflex. Different surgical modalities of treatment are available and Swenson's operation is one of the surgical procedures done for HD. Anorectal manometric findings may change after Swenson's operation with improvement of rectoanal inhibitory reflex in some cases. We aimed to evaluate functional results after Swenson's operation for HD using anorectal manometry.

PATIENTS AND METHODS

Between 1996 and 2005, 52 patients were diagnosed with HD and operated upon by Swenson's operation in Gastroenterology Center, Mansoura University. There were 33 males (63.46%) and 19 females (36.54%) with a mean age of 3.29 +/- 1.6, (range 2-17 years). Anorectal manometry and rectal muscle biopsy were done preoperatively for diagnosis but after operation anorectal manometry was done after every six months and then yearly.

RESULTS

All of the 52 patients showed absent rectoanal inhibitory reflex on manometric study with relatively higher resting anal canal pressure and within normal squeeze pressure. Postoperatively, there were 35 continent patients (67.31%) with 11 patients (21.15%) showing minor incontinence and six (11.54%) with major incontinence. On the other side, there were five patients (9.62%) with persistent constipation after operation (three due to anal stricture and two due to residual aganglionosis). Postoperative manometric study showed some improvement in anal sensation with the rectoanal inhibitory reflex becoming intact in six patients (11.54%) four years after operation.

CONCLUSION

Anorectal manometry is a more reliable method for diagnosis of HD than barium enema X-ray but for final diagnosis, it is reasonable to combine anorectal manometry with tissue biopsy. Functional outcome after Swenson's operation for HD may improve in some patients complaining of incontinence or constipation. Anorectal manometry may show improvement of the parameters after Swenson's operation.

Authors+Show Affiliations

Gastroenterology Surgical Center, Mansoura University, Mansoura, Egypt. gadelhak_n_eg@hotmail.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

20065571

Citation

Gad El-Hak, Nabil A., et al. "Functional Outcome After Swenson's Operation for Hirshsprung's Disease." Saudi Journal of Gastroenterology : Official Journal of the Saudi Gastroenterology Association, vol. 16, no. 1, 2010, pp. 30-4.
Gad El-Hak NA, El-Hemaly MM, Negm EH, et al. Functional outcome after Swenson's operation for Hirshsprung's disease. Saudi J Gastroenterol. 2010;16(1):30-4.
Gad El-Hak, N. A., El-Hemaly, M. M., Negm, E. H., El-Hanafy, E. A., Abdel Messeh, M. H., & Abdel Bary, H. H. (2010). Functional outcome after Swenson's operation for Hirshsprung's disease. Saudi Journal of Gastroenterology : Official Journal of the Saudi Gastroenterology Association, 16(1), 30-4. https://doi.org/10.4103/1319-3767.58765
Gad El-Hak NA, et al. Functional Outcome After Swenson's Operation for Hirshsprung's Disease. Saudi J Gastroenterol. 2010 Jan-Mar;16(1):30-4. PubMed PMID: 20065571.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Functional outcome after Swenson's operation for Hirshsprung's disease. AU - Gad El-Hak,Nabil A, AU - El-Hemaly,Mohamed M, AU - Negm,Emad H, AU - El-Hanafy,Ehab A, AU - Abdel Messeh,Magdy H, AU - Abdel Bary,Hala H, PY - 2010/1/13/entrez PY - 2010/1/13/pubmed PY - 2010/3/26/medline SP - 30 EP - 4 JF - Saudi journal of gastroenterology : official journal of the Saudi Gastroenterology Association JO - Saudi J Gastroenterol VL - 16 IS - 1 N2 - BACKGROUND/AIM: Hirschsprung's disease (HD) is one of the most common causes resulting in lower intestinal obstruction in children with atypical clinical symptoms and inconspicuous morphological findings by barium enema X-ray. Recently, this situation has been largely ameliorated by improvement of instrument for measurement of anorectal pressure. By now, anorectal manometry has been regarded as a routine means for functional assessment and diagnosis of HD. It is accurate in nearly all cases of HD with characteristic absence of rectoanal inhibitory reflex. Different surgical modalities of treatment are available and Swenson's operation is one of the surgical procedures done for HD. Anorectal manometric findings may change after Swenson's operation with improvement of rectoanal inhibitory reflex in some cases. We aimed to evaluate functional results after Swenson's operation for HD using anorectal manometry. PATIENTS AND METHODS: Between 1996 and 2005, 52 patients were diagnosed with HD and operated upon by Swenson's operation in Gastroenterology Center, Mansoura University. There were 33 males (63.46%) and 19 females (36.54%) with a mean age of 3.29 +/- 1.6, (range 2-17 years). Anorectal manometry and rectal muscle biopsy were done preoperatively for diagnosis but after operation anorectal manometry was done after every six months and then yearly. RESULTS: All of the 52 patients showed absent rectoanal inhibitory reflex on manometric study with relatively higher resting anal canal pressure and within normal squeeze pressure. Postoperatively, there were 35 continent patients (67.31%) with 11 patients (21.15%) showing minor incontinence and six (11.54%) with major incontinence. On the other side, there were five patients (9.62%) with persistent constipation after operation (three due to anal stricture and two due to residual aganglionosis). Postoperative manometric study showed some improvement in anal sensation with the rectoanal inhibitory reflex becoming intact in six patients (11.54%) four years after operation. CONCLUSION: Anorectal manometry is a more reliable method for diagnosis of HD than barium enema X-ray but for final diagnosis, it is reasonable to combine anorectal manometry with tissue biopsy. Functional outcome after Swenson's operation for HD may improve in some patients complaining of incontinence or constipation. Anorectal manometry may show improvement of the parameters after Swenson's operation. SN - 1998-4049 UR - https://www.unboundmedicine.com/medline/citation/20065571/Functional_outcome_after_Swenson's_operation_for_Hirshsprung's_disease_ L2 - http://www.saudijgastro.com/article.asp?issn=1319-3767;year=2010;volume=16;issue=1;spage=30;epage=34;aulast=Gad DB - PRIME DP - Unbound Medicine ER -