Anorectal manometric evaluation of children and adolescents postsurgery for Hirschsprung's disease.

BACKGROUND

Little is known about anorectal function in patients after surgery for Hirschsprung's disease. Therefore, the authors evaluated anorectal sphincter function after corrective surgery.

METHODS

Thirty-five patients were studied after corrective surgery for Hirschsprung's disease. Sixteen of them had anorectal manometry performed also before surgery. The clinical outcome, the highest anal resting pressure, the presence of the rectosphincteric reflex (RSR), and of high amplitude propulsive waves were evaluated.

RESULTS

A total of 89% were doing poorly. Three had a fair and only one had a good outcome at the time of manometry 4.4 years after corrective surgery. RSR was absent in 33 and abnormal in 2 patients. The preoperative anal resting pressure was 45 +/- 14 mm Hg and postoperatively 45 +/- 13 mm Hg (P >.3). The anal resting pressure was 44 +/- 16 mm Hg in the 19 patients evaluated only postoperatively. Propulsive waves > or =50 mm Hg were present in 60% of patients.

CONCLUSIONS

Four years postsurgery, patients had a persistent absence of RSR regardless of the type of surgery. There was no significant difference in anal resting pressure between patients with and without sphincterotomy or between different surgical procedures. The presence of propulsive waves was not a prognostic indicator for achieving bowel control.