Innervation of the entire internal anal sphincter in a mouse model of Hirschsprung’s disease: a first report

Abstract Background Most children have a successful outcome after a pull-through for Hirschsprung’s disease. Some may have persisting symptoms after the pull-through. They could be managed conservatively, need minor surgical procedures, or a redo pull-through will be required. In this study, we presented our results in the management of the obstructive complications after pull-through for Hirschsprung’s disease. Results During the specified time period from January 2011 to December 2015, 21 patients presented to our department with persistent constipation or recurrent enterocolitis after a pull-through for Hirschsprung’s disease. Their age ranged between 4 months and 5 years (mean 2 years, median 2.5 years). They were 13 males and 8 females. Eleven patients underwent initial trans-anal endorectal pull-through, 4 underwent Duhamel procedure, and 6 underwent abdominal Soave technique. Three of the 11 patients with initial trans-anal endorectal pull-through had a tight anastomotic stricture which responded well to dilatation, 2 had a long muscular cuff which was incised laparoscopically, 4 had spasm of the internal anal sphincter which was relieved by sphincterotomy, and 2 had residual aganglionosis which required a redo pull-through. Two of the 4 patients who underwent initial Duhamel procedure had a long spur which was divided using a stapler, and the other 2 patients had residual aganglionosis which required a redo pull-through. One of the 6 patients who underwent abdominal Soave technique developed a long tight stricture and required a redo pull-through; in 1 patient, biopsy confirmed hypoganglionosis of the whole colon and was managed medically, and 4 patients had spasm of the internal anal sphincter which was relieved in 1 of them by sphincterotomy and in 2 by botulinum toxin injection while the remaining patient did not improve by either sphincterotomy or botulinum toxin injection. Conclusion Persistent constipation or recurrent enterocolitis after pull-through for Hirschsprung’s disease should be managed according to the cause; they could be managed medically by simple surgical procedures, or a redo pull-through may be required.

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Role of nitric oxide in the internal anal sphincter of hirschsprung’s disease

World Journal of Surgery ◽

10.1007/s00268-002-6384-7 ◽

2002 ◽

Vol 26 (12) ◽

pp. 1493-1498 ◽

Cited By ~ 4

Author(s):

Ryouichi Tomita ◽

Shigeru Fujisaki ◽

Katsuhisa Tanjoh ◽

Masahiro Fukuzawa

Keyword(s):

Nitric Oxide ◽

Anal Sphincter ◽

Internal Anal Sphincter ◽

Hirschsprung's Disease ◽

Hirschsprung’S Disease

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A prospective study of botulinum toxin for internal anal sphincter hypertonicity in children with Hirschsprung's disease

Journal of Pediatric Surgery ◽

10.1053/jpsu.2000.19234 ◽

2000 ◽

Vol 35 (12) ◽

pp. 1733-1736 ◽

Cited By ~ 72

Author(s):

Robert K. Minkes ◽

Jacob C. Langer

Keyword(s):

Botulinum Toxin ◽

Prospective Study ◽

Anal Sphincter ◽

Internal Anal Sphincter ◽

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

A Prospective Study

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COMPARATIVE CHARACTERISTICS OF OUTCOMES AFTER SURGICAL TREATMENT OF THE HIRSCHPRUNG’S SHORT FORM DISEASE IN CHILDREN

Russian Journal of Pediatric Surgery ◽

10.18821/1560-9510-2019-23-4-181-187 ◽

2019 ◽

Vol 23 (4) ◽

pp. 181-187

Author(s):

Rasul I. Abaikhanov ◽

T. A. Prudnikova ◽

I. V. Kirgizov

Keyword(s):

Surgical Treatment ◽

Anal Sphincter ◽

Internal Anal Sphincter ◽

Hirschsprung's Disease ◽

Hirschsprung’S Disease ◽

Short Form ◽

Surgical Techniques ◽

Diagnostic Techniques ◽

Case Surgery ◽

Group 2

Actuality. The Hirschsprung’s disease is one of the leading pathologies in the digestive tract in children. Despite the variety of diagnostic techniques for this disease, none of them has an absolute certainty when the short form disease is suspected, and only the assessment of findings after complex examination plus clinical picture can result in establishing a reliable diagnosis. The authors analyze outcomes of surgical treatment of the Hirschspring’s short form disease in children when the technique of dosed dissection of the internal anal sphincter under ultrasound control was applied and compare these results with those when conventional surgical techniques were used. Material and methods. 83 children aged 1-17.5 y.o. with the established diagnosis of Hirschsprung’s disease and an ultrashort aganglionic segment were taken into the study. Patients were divided into two groups. Group 1 (41 patient) who had surgical correction by the Lynn technique; Group 2 ( 42 children) who were operated on by the new developed technique. Results. 74% (31 patient) of children who were operated on by the dosed dissection of the internal anal sphincter under ultrasound control had good results in their late postoperative period; 10 patients (24%) had satisfactory results; unsatisfactory outcome was seen in 1 patient (2%). In children , who were operated on by the Lynn technique, good results were in 23 patients (57%); satisfactory results in 15 patients (37%) and unsatisfactory result in 3 patients (6%). Conclusion. The rectal form of Hirschsprung’s disease with a short and ultrashort segment requires surgical treatment in the vast majority of cases. In this case, surgery with dosed dissection of the internal anal sphincter under ultrasound control can be a method of choice.

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