scholarly journals Anorectal Manometry on Children: A Moroccan Series and Literature Review

2021 ◽  
Vol 9 (B) ◽  
pp. 337-343
Author(s):  
HANANE DELSA ◽  
Ilham Serraj ◽  
Mohamed Khalis ◽  
Nawal Kabbaj
Keyword(s):  
Statistical Analysis ◽  
Fecal Incontinence ◽  
Gold Standard ◽  
Chronic Constipation ◽  
Anorectal Manometry ◽  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Biofeedback Therapy ◽  
Significant Difference ◽  
Resting Pressure

Introduction and objectives: Anorectal manometry is a test that evaluates the function of the rectum,but also the anus. It is useful for the diagnosis of several conditions like fecal incontinence and constipation.In children these tests are being increasingly used for all ages.The aim of this study was to determine the benefit of anorectal manometry in children and to report our experience. Material and Methods:Over a period of four years, 273children that underwent anorectal manometry were included in the study,their data and tests results were analyzed. Results:Out of 273 patients included,68,5% were boys and 31,5% were girls.The mean age was 9 years.154patients(51,6%) had Fecal incontinence(Group1),75children(27,5%) had chronic constipation(Group2),and both of them(Group3) were reported in 37children(13,6%).An awake manometry was  performed in 248children(91%) however this test under sedation allowed us the exclusion of Hirschsprung’s disease in 21children(84%).In group1, 25%patients had bad anal contraction.In groupe3, 21,6%children had bad anal contraction.The statistical analysis showed a significant difference in age(p=0.022) and resting pressure(p=0.050) between the three groups.Children with fecal incontinence had a higher rate of dyssynergy,80.2% and 83.8% in groups 1 and 3 respectively compared to 60.4% in patients with chronic constipation(p=0,852) Conclusion:The gold standard for the exploration of children’s terminal constipation and encopresis is the anorectal manometry.It is an important tool to establish diagnosis.In our study, this test allow the exclusion of Hirschsprung’s disease in infants with constipation,  in other hand we found a higher rate of dyssynergy in children with fecal incontinence(80%) which had allow us to propose a biofeedback therapy.

scholarly journals The Efficacy of Biofeedback Therapy for the Treatment of Fecal Incontinence After Soave Procedure in Children for Hirschsprung's Disease

2021 ◽  
Vol 9 ◽  
Author(s):  
Yuhang Yuan ◽  
Mengyao Xu ◽  
Heying Yang ◽  
Beibei Sun ◽  
Yanan Li ◽  
...  
Keyword(s):  
Fecal Incontinence ◽  
Effective Treatment ◽  
Anorectal Manometry ◽  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Complete Disappearance ◽  
Biofeedback Therapy ◽  
The Poor ◽  
Surgical Methods ◽  
Poor Group

Introduction: Hirschsprung's disease is a common digestive tract malformation in children, and the Soave procedure is one of the classic surgical methods for Hirschsprung's disease (HD). Fecal incontinence is one of the most common postoperative complications that can cause significant distress to the patients and their family, the incidence of which is 20% in a recent series. Biofeedback therapy (BFT) can be an effective treatment for managing anorectal disorders, but there has been little report of the efficacy of BFT for the treatment of fecal incontinence after the Soave procedure, and the main objective of this study is to evaluate it.Methods: We retrospectively analyzed postoperative fecal incontinence in 46 children who received the Soave procedure for HD and who received BFT at our institution from March 2016 to February 2020, which included 38 males and 8 females (mean age 8.1 years, from 3.7 to 14 years). Anal sphincter contraction training was performed using BFT for 10 days per session in the hospital, one time each day, and 20 min each time. BFT was performed by employing visual and verbal feedback techniques using the biofeedback instrument. Long-term functional outcomes were objectively assessed using the Rintala Bowel Function Score (RBFS), and the patients were scored according to the sum total as excellent (18–20 points, 0 case), good (11–16 points, 0 case), fair (9–11 points, 9 cases), or poor (6–9 points, 37 cases). Defecation questionnaires and anorectal manometry were completed pretreatment and after three, six, or nine sessions, and primary outcome measures of anorectal manometry were anal maximal contraction pressure (AMCP), anal longest contraction time (ALCT), rectal rest pressure (RRP), and anal rest pressure (ARP).Results: Followed up from 6 months to 4 years, the symptoms of fecal incontinence disappeared completely in 39 (84.78%) patients. Among them, 14 (30.43%) had complete disappearance of symptoms after 3 sessions of treatment, 25 (54.34%) patients had improved symptoms after 6 sessions of treatment, symptoms completely disappeared after 6 sessions of treatment, and 7 (15.22%) cases still suffered fecal incontinence mildly. The AMCP after three and six sessions in the poor group was significantly increased compared with that before treatment [(85.87 ± 31.75) mmHg vs. (135.33 ± 37.69) mmHg vs. (128.41 ± 33.45) mmHg, P < 0.05]. The ALCT and ARP showed the same trend, while the RRP after three and six sessions were not significant (P > 0.05). The mean (±SD) score of the RBFS increased from 9 to 17.40 ± 0.84 in the fair group, while it increased from 7.22 ± 0.76 to 16.58 ± 1.66 in the poor group after six sessions (P < 0.05).Conclusion: Biofeedback therapy is a safe and effective treatment of fecal incontinence after the Soave procedure of children for Hirschsprung's disease. It is beneficial to design the individualized treatment programs for the children with varying degrees of fecal incontinence.

Long-Term Outcomes and Quality of Life in Patients after Soave Pull-Through Operation for Hirschsprung's Disease: An Observational Retrospective Study

2017 ◽  
Vol 28 (05) ◽  
pp. 445-454 ◽  
Author(s):  
Tania Mahler ◽  
Martine Dassonville ◽  
Dinh Truong ◽  
Annie Robert ◽  
Philippe Goyens ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Fecal Incontinence ◽  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Bowel Function ◽  
Long Term Outcomes ◽  
Neurologic Impairment ◽  
Pull Through

Introduction Patients after pull-through operation for Hirschsprung's disease (HD) are at high risk of defecation disorders. This study aimed at investigating their long-term outcomes and quality of life (QoL) in comparison with controls. Patients and Methods Patients older than 5 years operated on for HD were interviewed to complete detailed questionnaires on bowel function. Patients without neurologic impairment were enrolled in a QoL survey to compare with controls matched for sex and age and selected randomly from the general population using sampling set in a ratio of four controls to one case of HD. Results In total, 53 operated patients were enrolled. Mean age of the patients was 16 ± 8 years, with 68% boys. Rectosigmoid aganglionosis was the most seen form of HD in 38 (72%) cases. Open Soave was performed in 40 (75.5%) cases, and minimally invasive surgery Soave (MIS Soave) in 13 (24.5%) cases. At investigation, prevalence of fecal incontinence and constipation were 22.6 and 13.2%, respectively. Regarding QoL survey, 45 patients and 180 controls were enrolled, excluding 8 patients with neurologic impairment. Thirty-seven (82.2%) patients were classified as having a good QoL (score ≥ 9 points); whereas six had a fair QoL (5–8 points) and two had a poor QoL (< 5 points). QoL score in the cases and the controls were 10.2 ± 2.5 and 11.9 ± 0.4 points, respectively. Long aganglionosis form of HD was significantly associated with a low QoL (score < 8 points), adjusted odds ratio = 9, 95% confidence interval [1.3; 64.1] (p < 0.05). In subscales analyses, the prevalence of each dimension including fecal continence, school absenteeism, unhappiness or anxiety, food restriction, and peer rejection was significantly higher in operated patients than in controls (p <0.001). Conclusion Although the QoL of patients operated on for HD in general was with good outcomes, fecal incontinence and constipation still are problematic issues and challenges in a high percentage of patients. Therefore, a long-term and multidisciplinary follow-up is essentially required for these patients.

scholarly journals Interest of Anorectal Manometry During Long-term Follow-up of Patients Operated on for Hirschsprung's Disease

2018 ◽  
Vol 24 (1) ◽  
pp. 70-78 ◽  
Author(s):  
Viet Q Tran ◽  
Tania Mahler ◽  
Patrick Bontems ◽  
Dinh Q Truong ◽  
Annie Robert ◽  
...  
Keyword(s):  
Anorectal Manometry ◽  
Hirschsprung's Disease ◽  
Hirschsprung’S Disease ◽  
Long Term Follow Up

Anorectal Manometry in Men and Women with Chronic Constipation and Fecal Incontinence

2013 ◽  
Vol 108 ◽  
pp. S564
Author(s):  
Deva Gundupalli ◽  
Stephanie Hatton-Ward ◽  
Mae Go ◽  
Ashok Tuteja
Keyword(s):  
Fecal Incontinence ◽  
Chronic Constipation ◽  
Anorectal Manometry ◽  
Men And Women

scholarly journals Effect of patient positioning on the duration of venous reflux in duplex ultrasound for venous insufficiency

Ultrasound ◽  
2012 ◽  
Vol 20 (2) ◽  
pp. 92-97
Author(s):  
M Bonfield ◽  
F Cramp ◽  
T Robinson
Keyword(s):  
Statistical Analysis ◽  
Gold Standard ◽  
Venous Insufficiency ◽  
Duplex Ultrasound ◽  
Patient Positioning ◽  
Standing Position ◽  
Venous Reflux ◽  
Significant Difference ◽  
The Mean ◽  
Professional Guidelines

Introduction There is currently little research regarding optimum patient position for venous insufficiency assessment although standing is considered the gold standard in many professional guidelines. Some patients are unable to stand for the examination and scanning patients in a standing position is physically challenging for the sonographer. This pilot study aimed to evaluate the effect of varying patient positioning on the duration of venous reflux. Method Venous reflux duration was measured in symptomatic participants with suspected venous insufficiency. Measurements were taken in the standing position (gold standard) and four alternative positions: 25° reverse-Trendelenburg (RT) tilt, sitting on the edge of the examination couch, 10° RT tilt and 0° RT tilt. The mean reflux duration measured in each different position was compared with the gold standard. Results Complete measurements were obtained from 16 patients (8 men and 8 women). For an incompetent vein, statistical analysis demonstrated a significant difference only between the standing position and the 0° position ( U = 19.0; exact P < 0.01 [2-tailed]). Conclusion Results suggest that several alternative positions could be used for assessing incompetent veins as long as the patient is not lying supine with 0° tilt. This would offer much greater flexibility, which may be of benefit to both patients and sonographers.

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