Reconstructing the anal sphincters to reverse iatrogenic overstretching following a pull-through for Hirschsprung disease One-year outcomes | 6 patients with Hirschsprung disease referred for post pull-through soiling | New technique for anal sphincter reconstruction | One-year outcomes | At referral | all patients had soiling without voluntary bowel movements (VBM) | 1 was clean on Malone flushes | After sphincter reconstruction | 3 were able to close their sphincters | 1 patient gained total bowel control w/out antegrade flushes | 3 patients now have VBM and use antegrade flushes intermittently | 2 patients w/ Down syndrome required a redo pull-through for other indications | Sphincter reconstruction operative technique | Conclusion: A new technique for sphincter reconstruction can result in improved bowel control at one year. | https://doi.org/10.1016/j.jpedsurg.2022.10.052 | Source: Bokova E et.al. | @EmTombash | @StayCurrentMD | Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, D.C., USA | Cincinnati Children's | Journal of Pediatric Surgery
Reconstructing the anal sphincters to reverse iatrogenic overstretching following a pull-through for Hirschsprung disease. One-year outcomes
Infographic · May 2023 · 1 min read
In brief
In brief
This study reports one-year outcomes of anal sphincter reconstruction in six Hirschsprung disease patients with post-pull-through soiling from iatrogenic sphincter damage. Four of six patients without Down syndrome showed significant improvement in continence scores, with some achieving voluntary bowel movements for the first time.
- Iatrogenic anal sphincter damage from initial pull-through is a correctable cause of post-operative soiling in Hirschsprung patients.
- Sphincter reconstruction restored voluntary bowel movements in 4/4 non-Down syndrome patients who previously had none.
- 3D anorectal manometry objectively confirmed improved sphincter closure function post-reconstruction in tested patients.
- Patients reported meaningful quality-of-life gains: ability to participate in sports and leave home with confidence in bowel control.
- Abbreviated Baylor Continence Scale improved 6-fold (0.75→4.5) in non-Down syndrome cohort at 12-month follow-up.
Written by the GCMD Library team from the infographic.
The infographic uses a teal, white, and yellow color scheme with anatomical illustrations showing the surgical technique. The left side displays cross-sectional diagrams of the anal sphincter before and after reconstruction, with arrows indicating the reconstruction process. The right side features a cartoon illustration of an infant and bullet-pointed outcome data. The layout flows from top to bottom, presenting the problem, technique, and results.
Elizaveta Bokova, Elise McKenna, Wilfried Krois, Carlos A. Reck, Tamador Al-Shamaileh, Shimon E. Jacobs, Laura Tiusaba, Teresa L. Russell, Anil Darbari, Christina Feng, Andrea T. Badillo, Marc A. Levitt
Background: In patients with Hirschsprung disease (HSCR), soiling may be related to anal sphincter damage following the initial pull-through. No optimal treatment has been developed for such patients, although enemas (rectal or antegrade) have been applied with some success. We present the one-year outcomes of a new technique for anal sphincter reconstruction.
Methods: All patients with HSCR referred from other institutions for post pull-through soiling were studied. Seven patients with patulous sphincters underwent sphincter reconstruction. Six had a full preoperative evaluation and were included in the study. Their 12-month outcomes were assessed.
Results: All six patients had soiling without voluntary bowel movements (VBMs). One patient was clean on Malone flushes when referred. Three underwent pre- and post-reconstruction non-sedated three-dimensional anorectal manometry, and objectively were able to close their sphincters following the reconstruction. All patients without Down syndrome (4 of 6) showed improvement in the abbreviated Baylor Continence Scale (4.5 vs. 0.75). One patient has achieved total bowel control without antegrade flushes, three now have VBMs which they did not have before but have occasional accidents and use antegrade flushes intermittently. They reported higher productivity, the ability to participate in sports and be away from home with confidence in their regimen. Two of 6 patients have Down syndrome and required a redo pull-through for other indications and underwent empiric sphincter reconstruction. For these two patients we do not have an outcomes assessment.