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

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A Letter to the Editor to this article was published on 14 October 2019

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.

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Authors and Affiliations

  1. Division of Pediatric Surgery, Department of Surgery, University of California, Davis, CA, USA

    P. Saadai & A. F. Trappey

  2. Pediatric Colorectal Center, Shriners Hospitals for Children, Northern California, 2425 Stockton Blvd, Sacramento, CA, 95818, USA

    P. Saadai & A. F. Trappey

  3. Department of Pediatric Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA

    A. M. Goldstein

  4. Section of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA

    R. A. Cowles

  5. Colorectal Center for Children At Children’s Hospital of Pittsburgh, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    L. De La Torre

  6. Division of Pediatric Surgery, Emory University School of Medicine and Children’s Healthcare of Atlanta, Atlanta, GA, USA

    M. M. Durham

  7. Department of Surgery and Pediatrics, The University of Tennessee Health Science Center, Memphis, TN, USA

    E. Y. Huang

  8. Center for Colorectal and Pelvic Reconstruction, Nationwide Children’s Hospital, Columbus, OH, USA

    M. A. Levitt

  9. Division of General and Thoracic Surgery, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada

    K. Rialon & J. C. Langer

  10. Primary Children’s Hospital, University of Utah School of Medicine, Salt Lake City, UT, USA

    M. Rollins

  11. Department of Pediatric Surgery, Women and Children’s Hospital of Buffalo, Buffalo, NY, USA

    D. H. Rothstein

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  1. P. Saadai
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  2. A. F. Trappey
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  3. A. M. Goldstein
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  4. R. A. Cowles
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  5. L. De La Torre
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  6. M. M. Durham
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  7. E. Y. Huang
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  8. M. A. Levitt
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  9. K. Rialon
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  10. M. Rollins
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  11. D. H. Rothstein
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  12. J. C. Langer
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The American Pediatric Surgical Association Hirschsprung Disease Interest Group

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Correspondence to P. Saadai.

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Saadai, P., Trappey, A.F., Goldstein, A.M. et al. Guidelines for the management of postoperative soiling in children with Hirschsprung disease. Pediatr Surg Int 35, 829–834 (2019). https://doi.org/10.1007/s00383-019-04497-y

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  • DOI: https://doi.org/10.1007/s00383-019-04497-y

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