Defecation Dis
Defecation
Disorders after Surgery for Hirschsprung’s Disease in Children; an Iranian
Experience
Saeid Aslanabadi 1,
Davod Badebarin 1, Masoud Jamshidi 1, Mahbuba
Valinejad 2, Kamyar Ghabili 3, Samad EJ
Golzari 4,5, Hadi Mohammad Khanli 6, Babak
Sabermarouf 7
1. Pediatric Health Research Center, Tabriz
University of Medical Sciences, Tabriz, Iran
2. Faculty of Medicine, Tabriz University of
Medical Sciences, Tabriz, Iran
3. Physical Medicine and Rehabilitation Research
Center, Tabriz University of Medical Sciences, Tabriz, Iran
4. Cardiovascular Research Center, Tabriz
University of Medical Sciences, Tabriz, Iran
5. Students’ Research Committee, Tabriz University
of Medical Sciences, Tabriz, Iran
6. Medical Philosophy and History Research Center,
Tabriz University of Medical Sciences, Tabriz, Iran
7. Neurosciences Research Center (NSRC), Tabriz
University of Medical Sciences, Tabriz, Iran
Abstract: Hirschsprung’s
disease (HD) is a congenital disease of the intestinal nervous system
characterized by absence of ganglionic cells in distal colon followed by
functional obstruction. After corrective surgery, the majority of children with
HD develop defecation disorders such as soiling, constipation, fecal
incontinence, and/or enterocolitis. The aim of this investigation was to
determine the prevalence, diagnoses, therapies, and 6-month clinical outcomes
in children with HD after corrective surgery. In this cross-sectional study
performed at pediatric surgery ward in Tabriz Children’s Hospital, prevalence,
diagnosis and treatment of defecation disorders after surgery for HD were
studied. First, defecation pattern was determined in 230 HD patients who had
undergone surgery within previous ten years. Later, thirty patients with severe
defecation disorders were recruited. Diagnostic and therapeutic procedures were
performed. Clinical outcome was evaluated after six months. Defecation pattern
was normal in 65% of the patients. In 21% of the cases, defecation disorders
were mild and negligible, with no need of treatment. In 13% (30 patients), the
pattern was impaired. Soiling, constipation, fecal incontinence and
enterocolitis were the postoperative disorders. Of 30 patients with defecation
disorders, 18 children (60%) and 12 patients (40%) had undergone multi-stage
and TOSEPT surgical procedures, respectively. Defecation disorder was developed
in 25.3% and 7.7% of the patients underwent multi-stage and transanal one-stage
endorectal pull-through (TOSEPT) surgical procedures, respectively. Twelve
patients and 10 children were treated with reoperation and medical therapy,
respectively. Clinical outcome was excellent in five patients (16.7%), good in
15 patients (50%), fair in 8 patients (26.7%), and poor in 2 patients (6.6%).
In conclusion, majority of the children with HD and postoperative defecation
disorders have a favorable long-term clinical outcome when treated with
minimally invasive surgical methods such as TOSEPT. Moreover, postoperative defecation
disorders can be successfully treated using surgical procedures, medical
therapy, as well as teaching both parents and their children.
[Aslanabadi
S, Badebarin D, Jamshidi M, Valinejad M, Ghabili K, Golzari SE, Khanli HM,
Sabermarouf B. Defecation Disorders after Surgery for Hirschsprung’s
Disease in Children; an Iranian Experience. Life
Sci J 2013;10(7s):8-11] (ISSN:1097-8135).http://www.lifesciencesite.com. 2
Keywords: Hirschsprung’s disease; defecation disorder; TOSEPT
