Importance of anorectal manometry after defi nitive surgery for Hirschsprung’s disease in children

Abstract

Objectives: The purpose of this investigation is to evaluate anorectal function after defi nitive surgery for Hirschsprung’s disease (HD) by  anorectal manometry.

Materials and Methods: We evaluated the anorectal manometric  assessment of 18 children who were operated for HD. Functional outcomes
were determined by a questionnaire. Rectoanal inhibitory refl ex (RAIR) and maximum anal resting pressure (MARP) were monitored. The results were compared between obstructive patients and asymptomatic patients.

Results: The median age at defi nitive operation was 19 months (range 12–72 months). Anorectal manometry was performed in 14 male and 4 female patients. All the cases underwent three staged procedure for HD  and modifi ed Duhamel procedure was performed as defi nitive procedure for all the patients. Mean age was 4.3 months (range 25 days to 5 years) at time of diagnosis. Post-operative enterocolitis or severe constipation  was observed in seven patients (38.8%). There were no patients with incontinence. Eighteen patients underwent anorectal manometry meanly 2 years after defi nitive operation. RAIR was absent in 14 (77.7%) patients and abnormal in 4 (22.2%). There were no signifi cant differences in the MARP values between symptomatic and asymptomatic patients.

Conclusion: The results of our study showed that the majority of the  patients have impaired anorectal motility. There were no signifi cant
differences in the results of the functional studies for the seven patients with symptoms of obstruction or constipation when compared with  asymptomatic patients after surgery for HD.

Key words: Hirschsprung’s disease, anorectal manometry, constipation, enterocolitis, complications