Defecation Disorde
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
