Fecal incontinence after the surgical treatment of Hirschsprung disease

Abstract Background Simple anal fistula is one of the most common causes of proctological surgery and fistulotomy is considered the gold standard. This procedure, however, may cause complications. The aim of this systematic review was to assess the surgical treatment of simple anal fistula with traditional and sphincter-sparing techniques. Methods A literature research was performed using PubMed, Cochrane, and Google Scholar to identify studies on the surgical treatment of simple anal fistulas. Observational studies and randomized clinical trials were included. We assessed the risk of bias of included studies using the Jadad scale for randomized controlled trials, and the MINORS Scale for the remaining studies. Results The search returned 456 records, and 66 studies were found to be eligible. The quality of the studies was generally low. A total of 4883 patients with a simple anal fistula underwent a sphincter-cutting procedure, mainly fistulotomy, with a weighted average healing rate of 93.7%, while any postoperative continence impairment was reported in 12.7% of patients. Sphincter-sparing techniques were adopted to treat 602 patients affected by simple anal fistula, reaching a weighted average success rate of 77.7%, with no study reporting a significant postoperative incontinence rate. The postoperative onset of fecal incontinence and the recurrence of the disease reduced patients’ quality of life and satisfaction. Conclusions Surgical treatment of simple anal fistulas with sphincter-cutting procedures provides excellent cure rates, even if postoperative fecal incontinence is not a negligible risk. A sphincter-sparing procedure could be useful in selected patients.

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Surgical treatment of rectal prolapse: experience and late results with 51 patients

Revista do Hospital das Clínicas ◽

10.1590/s0041-87812004000400003 ◽

2004 ◽

Vol 59 (4) ◽

pp. 168-171 ◽

Cited By ~ 4

Author(s):

Carlos Walter Sobrado ◽

Desidério Roberto Kiss ◽

Sérgio C. Nahas ◽

Sérgio E. A. Araújo ◽

Victor E. Seid ◽

...

Keyword(s):

Surgical Treatment ◽

Fecal Incontinence ◽

Rectal Prolapse ◽

Late Results ◽

Long Term Results ◽

Complete Rectal Prolapse ◽

Presacral Space ◽

Perineal Rectosigmoidectomy ◽

Study Results ◽

Low Incidence

The "best" surgical technique for the management of complete rectal prolapse remains unknown. Due to its low incidence, it is very difficult to achieve a representative number of cases, and there are no large prospective randomized trials to attest to the superiority of one operation over another. PURPOSE: Analyze the results of surgical treatment of complete rectal prolapse during 1980 and 2002. METHOD: Retrospective study. RESULTS: Fifty-one patients underwent surgical treatment during this period. The mean age was 56.7 years, with 39 females. Besides the prolapse itself, 33 patients complained of mucous discharge, 31 of fecal incontinence, 14 of constipation, 17 of rectal bleeding, and 3 of urinary incontinence. Abdominal operations were performed in 36 (71%) cases. Presacral rectopexy was the most common abdominal procedure (29 cases) followed by presacral rectopexy associated with sigmoidectomy (5 cases). The most common perineal procedure was perineal rectosigmoidectomy associated with levatorplasty (12 cases). Intraoperative bleeding from the presacral space developed in 2 cases, and a rectovaginal fistula occurred in another patient after a perineal rectosigmoidectomy. There were 2 recurrences after a mean follow-up of 49 months, which were treated by reoperation. CONCLUSION: Abdominal and perineal procedures can be used to manage complete rectal prolapse with safety and good long-term results. Age, associated medical conditions, and symptoms of fecal incontinence or constipation are the main features that one should bear in mind in order to choose the best surgical approach.

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Results of the Surgical Treatment in Children with Hirschprung Disease: A 12-Year Experience

Turkish Association of Pediatric Surgeons ◽

10.5222/jtaps.2021.49092 ◽

2021 ◽

Author(s):

Ceren Cesur ◽

Ayşenur Celayir

Keyword(s):

Surgical Treatment ◽

Complication Rate ◽

Operative Procedure ◽

Surgical Techniques ◽

Hirschsprung Disease ◽

Rectal Biopsy ◽

X Rays ◽

Surgical Methods ◽

Pull Through ◽

Subacute Intestinal Obstruction

Objective: In the treatment of Hirschsprung’s disease, many surgical techniques have been developed and modified including laparotomy, resection of the affected colon segment, and pull-through of the functional bowel segment to the anus. Conventional surgical methods have many early and late postoperative complications, albeit at a reduced rate today. In this study, it was aimed to compare the treatment results of children with Hirschsprung Disease who were operated with single or two-stage techniques in our department. Method: Hospital records of the patients operated for Hirschsprung disease were retrospectively evaluated. Demografic characteristics, findings of physical and rectal examinations, X-rays findings, rectal biopsy results, surgical treatment methods and outcomes were analyzed. Results: Fifty-two children including 41-male (78.8%) and 11-female (21.2%) patients with age ranging from 1-day to 5-year and mean age of 6.8-day in neonates and 6.3-month in others were enrolled in the study. All patients presented with acute or subacute intestinal obstruction. Levels were observed on supine abdominal radiographs in all; transition zone and retention of opaque material were observed on opaque enema or retention radiographs.In patients whose rectal biopsies revealed aganglionic megacolon two staged procedures were performed including initial colostomy followed by definitive procedure of Duhamel with stapler in 30, and Soave in 12, and Swenson in 1 patient. Nine patients were operated with one-stage endorectal pull-through technique. The complication rate in 43 patients with Hirschsprung disease managed by two staged operative procedure was (78.8%), and it was 11.1% in 9 cases that underwent transanal endorectal pullthrough procedure. It was learned that effective anal dilatation was not performed in 22-patients who had postoperative enterocolitis attacks. Conclusion: In addition to the low complication rate, the morbidity rates in the transanal endorectal pull-through method, which achieved successful results with only one procedure, were very low compared to multiple-stage operations.

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Techniques and Instruments: Surgical treatment of fecal incontinence

Plastic & Reconstructive Surgery ◽

10.1097/00006534-197709000-00088 ◽

1977 ◽

Vol 60 (3) ◽

pp. 485

Author(s):

W V Lumb

Keyword(s):

Surgical Treatment ◽

Fecal Incontinence

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Surgical Treatment Options For Fecal Incontinence

The Internet Journal of Surgery ◽

10.5580/1c30 ◽

2001 ◽

Vol 1 (2) ◽

Keyword(s):

Surgical Treatment ◽

Fecal Incontinence ◽

Treatment Options

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Surgical Treatment Options For Fecal Incontinence

The Internet Journal of Gastroenterology ◽

10.5580/2952 ◽

2001 ◽

Vol 1 (2) ◽

Keyword(s):

Surgical Treatment ◽

Fecal Incontinence ◽

Treatment Options

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A Comparative Study between Swenson Abdominoperineal Pull-through and Transanal, Full Thickness, Swenson like Approach for Hirschsprung Disease

Bangladesh Critical Care Journal ◽

10.3329/bccj.v5i1.32538 ◽

2017 ◽

Vol 5 (1) ◽

pp. 23-27

Author(s):

Khalid Mahmud ◽

MK Islam ◽

M Rashedul Alam ◽

Sabbir Karim

Keyword(s):

Urinary Incontinence ◽

Fecal Incontinence ◽

Comparative Study ◽

Operation Time ◽

Hirschsprung Disease ◽

Paediatric Surgery ◽

Full Thickness ◽

Group A ◽

Pull Through ◽

Group B

Background: Hirschsprung disease (HD) is a congenital developmental disorder of intrinsic component of enteric nervous system leading to severe complication which needs operative correction. There are different operative techniques existing and each technique has its advantages and disadvantages.Objective: The aim of the study was to evaluate the better outcome between Transanal full thickness swenson like pull through and Swenson abdomino-perineal pull through.Method: The Prospective comparative study had been carried out in the department of paediatric surgery, Dhaka Shishu (Children) Hospital during the period of January 2014 to July 2016. Total 56 patients with HD patients were included in the study irrespective of colostomy except major co-morbidities which can influence the general outcomes and who did not agree to close stoma within 12 weeks of pull-through operation. Patients were allocated in both groups by purposing sampling. Twenty eight patients with long segment HD were allocated in Group-A and operated by Swenson abdominoperineal pull through and 28 patients with short segment disease were allocated in group-B and operated by Transanal, full thickness, swenson like procedure.Result: Among the study population 32 (57.14%) were male and 24 (42.86%) were female with age range was 1 day- 96 months. Four patients developed urinary incontinence, 3 patients developed cuff abscess and 2 patients developed fecal incontinence. And in group-B no patient developed urinary incontinence but 4 developed cuff and anastomotic abscess and no patient developed fecal incontinence. The mean operation time 114.14 ± 13.02 in group-A and 68.36 ± 16.12 minutes in group-B. Mean hospital stay in group-A was 6.18 ± 1.83 days and 5.05 ± 0.43 days in group-B.Conclusion: The newer modification, Transanal, full thickness Swenson like procedure can be better technique in the management of HD.Bangladesh Crit Care J March 2017; 5(1): 23-27

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CLINICAL AND MANOMETRIC ASSESMENT OF FUNCTIONAL STATE OF ANAL SPHINCTER IN PATIENTS AFTER FISTULECTOMY WITH PRIMARY SPHINCTEROPLASTY

Koloproktologia ◽

10.33878/2073-7556-2018-0-4-31-38 ◽

2018 ◽

pp. 31-38 ◽

Cited By ~ 1

Author(s):

I. V. Kostarev ◽

O. Yu. Fomenko ◽

A. Yu. Titov ◽

L. A. Blagodarni ◽

S. V. Belousova ◽

...

Keyword(s):

Surgical Treatment ◽

Fecal Incontinence ◽

Anal Sphincter ◽

Anorectal Manometry ◽

Clinical Symptoms ◽

Normal Pressure ◽

Wilcoxon Test ◽

Anal Pressure ◽

Wexner Score ◽

Resting Anal Pressure

AIM: to evaluate changes of anorectal manometry parameters and clinical symptoms of fecal incontinence 3 months after fistulectomy with primary sphincteroplasty. MATERIALS AND METHODS: fifty-two patients (37 males) with complex anal fistulae of cryptoglandular origin underwent fistulectomy and primary sphincteroplasty. The fistulas were recurrent in 13 (25 %) cases, 8 (15,4 %) patients had preoperative fecal incontinence. Fecal incontinence Wexner score was 0,46 (0-8) before surgery. Anorectal manometry was performed before and 3 months after surgery. RESULTS: three months days after surgery mean and maximum resting anal pressure were not significantly low compared with the baseline. In patients with initially normal data before the surgery (n=22), resting anal pressure was significantly lower (before surgery M=56,1 ± 7,6 [46,1-69,0], after surgery 45,5 ± 8,8 [38,0-63,0], p=0,006, Wilcoxon test). There were no significant changes in squeezing anal pressure. Resting anal pressure has become below the normal after surgery in 13 (59.1 %) patients. Clinical symptoms of fecal incontinence was detected in 10 patients postoperatively (gas incontinence and soiling). Fecal incontinence Wexner score was 1,64 (0-11) after surgery (p=0,007). CONCLUSION: fistulectomy with primary sphincteroplasty leads to change of resting anal pressure basically in patients with initially normal pressure and mainly - in patients with anterior fistulas. Fecal incontinence symptoms after with surgery produced 26,3 % patients. These data confirm the need of individual approach when choosing the method of surgical treatment of analfistulae.

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