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Guidelines for the management of postoperative soiling in children with Hirschsprung disease

  • P. SaadaiEmail author
  • A. F. Trappey
  • A. M. Goldstein
  • R. A. Cowles
  • L. De La Torre
  • M. M. Durham
  • E. Y. Huang
  • M. A. Levitt
  • K. Rialon
  • M. Rollins
  • D. H. Rothstein
  • J. C. Langer
  • The American Pediatric Surgical Association Hirschsprung Disease Interest Group
Review Article
  • 45 Downloads

Abstract

Although most children with Hirschsprung disease ultimately achieve functional and comfortable stooling, some will experience a variety of problems after pull-through surgery. The most common problems include soiling, obstructive symptoms, enterocolitis, and failure to thrive. The purpose of this guideline is to present a rational approach to the management of postoperative soiling in children with Hirschsprung disease. The American Pediatric Surgical Association Hirschsprung Disease Interest Group engaged in a literature review and group discussions. Expert consensus was then used to summarize the current state of knowledge regarding causes, methods of diagnosis, and treatment approaches to children with soiling symptoms following pull-through for Hirschsprung disease. Causes of soiling after pull-through are broadly categorized as abnormalities in sensation, abnormalities in sphincter control, and “pseudo-incontinence.” A stepwise algorithm for the diagnosis and management of soiling after a pull-through for Hirschsprung disease is presented; it is our hope that this rational approach will facilitate treatment and optimize outcomes.

Keywords

Hirschsprung disease Soiling Incontinence Pseudo-incontinence Bowel management Pull-through 

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

References

  1. 1.
    Dasgupta R, Langer JC (2008) Evaluation and management of persistent problems after surgery for Hirschsprung disease in a child. J Pediatr Gastroenterol Nutr. 46(1):13–19CrossRefGoogle Scholar
  2. 2.
    Levitt MA, Dickie B, Pena A (2012) The Hirschsprungs patient who is soiling after what was considered a "successful" pull-through. Semin Pediatr Surg. 21(4):344–353CrossRefGoogle Scholar
  3. 3.
    Langer JC, Rollins MD, Levitt M, Gosain A, Torre L, Kapur RP et al (2017) Guidelines for the management of postoperative obstructive symptoms in children with Hirschsprung disease. Pediatr Surg Int. 33(5):523–526CrossRefGoogle Scholar
  4. 4.
    Kaul A, Garza JM, Connor FL, Cocjin JT, Flores AF, Hyman PE et al (2011) Colonic hyperactivity results in frequent fecal soiling in a subset of children after surgery for Hirschsprung disease. J Pediatr Gastroenterol Nutr. 52(4):433–436CrossRefGoogle Scholar
  5. 5.
    Langer JC (2012) Hirschsprung disease. In: Coran AG, Grosfeld JL, James A, O'Neill J, Fonkalsrud EW (eds) Pediatric surgery, 7th edn. Elsevier, AmsterdamGoogle Scholar
  6. 6.
    Martin LW, Torres AM, Fischer JE, Alexander F (1985) The critical level for preservation of continence in the ileoanal anastomosis. J Pediatr Surg. 20(6):664–667CrossRefGoogle Scholar
  7. 7.
    Sun X, Wang R, Zhang L, Li D, Li Y (2012) Efficacy of pelvic floor muscle training for the treatment of fecal incontinence after Soave procedure for Hirschsprung disease. Eur J Pediatr Surg = Zeitschrift fur Kinderchirurgie 22(4):300–304Google Scholar
  8. 8.
    Banasiuk M, Banaszkiewicz A, Piotrowski D, Albrecht P, Kaminski A, Radzikowski A (2016) 3D high-definition manometry in evaluation of children after surgery for Hirschsprung's disease: A pilot study. Advances in medical sciences. 61(1):18–22CrossRefGoogle Scholar
  9. 9.
    Di Lorenzo C, Solzi GF, Flores AF, Schwankovsky L, Hyman PE (2000) Colonic motility after surgery for Hirschsprung's disease. The American journal of gastroenterology. 95(7):1759–1764CrossRefGoogle Scholar
  10. 10.
    Rodriguez L, Sood M, Di Lorenzo C, Saps M (2017) An ANMS-NASPGHAN consensus document on anorectal and colonic manometry in children. Neurogastroenterol Motil 29(1):e12944CrossRefGoogle Scholar
  11. 11.
    Hsu WM, Chen CC (1999) Clinical and manometric evaluation of postoperative fecal soiling in patients with Hirschsprung’s disease. J Formos Med Assoc = Taiwan yi zhi 98(6):410–414Google Scholar
  12. 12.
    Wildhaber BE, Pakarinen M, Rintala RJ, Coran AG, Teitelbaum DH (2004) Posterior myotomy/myectomy for persistent stooling problems in Hirschsprung's disease. J Pediatr Surg 39(6):920–926CrossRefGoogle Scholar
  13. 13.
    Minkes RK, Langer JC (2000) A prospective study of botulinum toxin for internal anal sphincter hypertonicity in children with Hirschsprung's disease. J Pediatr Surg. 35(12):1733–1736CrossRefGoogle Scholar
  14. 14.
    Santoro GA, Eitan BZ, Pryde A, Bartolo DC (2000) Open study of low-dose amitriptyline in the treatment of patients with idiopathic fecal incontinence. Dis Colon Rectum 43(12):1676–1681CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • P. Saadai
    • 1
    • 2
    Email author
  • A. F. Trappey
    • 1
    • 2
  • A. M. Goldstein
    • 3
  • R. A. Cowles
    • 4
  • L. De La Torre
    • 5
  • M. M. Durham
    • 6
  • E. Y. Huang
    • 7
  • M. A. Levitt
    • 8
  • K. Rialon
    • 9
  • M. Rollins
    • 10
  • D. H. Rothstein
    • 11
  • J. C. Langer
    • 9
  • The American Pediatric Surgical Association Hirschsprung Disease Interest Group
  1. 1.Division of Pediatric Surgery, Department of SurgeryUniversity of CaliforniaDavisUSA
  2. 2.Pediatric Colorectal Center, Shriners Hospitals for ChildrenSacramentoUSA
  3. 3.Department of Pediatric Surgery, Harvard Medical SchoolMassachusetts General HospitalBostonUSA
  4. 4.Section of Pediatric Surgery, Department of SurgeryYale University School of MedicineNew HavenUSA
  5. 5.Colorectal Center for Children At Children’s Hospital of PittsburghUniversity of Pittsburgh Medical Center, University of Pittsburgh School of MedicinePittsburghUSA
  6. 6.Division of Pediatric SurgeryEmory University School of Medicine and Children’s Healthcare of AtlantaAtlantaUSA
  7. 7.Department of Surgery and PediatricsThe University of Tennessee Health Science CenterMemphisUSA
  8. 8.Center for Colorectal and Pelvic ReconstructionNationwide Children’s HospitalColumbusUSA
  9. 9.Division of General and Thoracic Surgery, Department of Surgery, Hospital for Sick ChildrenUniversity of TorontoTorontoCanada
  10. 10.Primary Children’s HospitalUniversity of Utah School of MedicineSalt Lake CityUSA
  11. 11.Department of Pediatric Surgery, Women and Children’s Hospital of BuffaloBuffaloUSA

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