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


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.


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




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.


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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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