Abstract

The anal canal is the fine line between "fecal incontinence and colitis" after a pull-through for Hirschsprung disease

De la Torre L1, Cogley K2, Santos K3, Morales O2, Calisto J2. J Pediatr Surg. 2017 Sep 4. pii: S0022-3468(17)30537-7. doi: 10.1016/j.jpedsurg.2017.08.040. [Epub ahead of print]
 
     
Author information

1 Colorectal and Hirschsprung Center for Children at Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, USA. Electronic address: luis.delatorre@chp.edu. 2 Colorectal and Hirschsprung Center for Children at Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, USA. 3 Department of Surgery, Instituto Nacional de Pediatría, Ciudad de México, Mexico.

Abstract

BACKGROUND/PURPOSE: Fecal incontinence after a pull-through is associated with different factors, although damage to the anal canal seems to be the most important. The objective of this article is to identify the variables related to the presence of fecal control and colitis in a homogeneous group of children after pull-through.

METHODS: A retrospective cross-sectional study was performed in patients with HD for evaluation of post-operative problems from May 2014 to November 2016. The patients (39) had a transanal approach and were divided into two groups: Group 1 patients with fecal continence and Group 2 patients with fecal incontinence.

RESULTS: Group 1 patients (13) had the anastomosis in the rectum, no damage to the anal canal, and a positive history of colitis. Group 2 (26) had the anastomosis at the skin, anoderm, pectinate line, or a combination of these and a negative history of colitis.

CONCLUSIONS: We demonstrated that patients with a technical error in the anastomosis have fecal incontinence, but not colitis. Preservation of the anal canal is associated with fecal control and colitis because it is a high-pressure zone. Education for proper identification of the anal canal during a pull-through is an absolute necessity.

TYPE OF STUDY: Retrospective Comparative Study. LEVEL OF EVIDENCE: Level III.

© Copyright 2013-2018 GI Health Foundation. All rights reserved.
This site is maintained as an educational resource for US healthcare providers only. Use of this website is governed by the GIHF terms of use and privacy statement.