Postoperative Fecal Function Study Of Transanal Endorectal Pull-through With Partial Internal Sphincter Myoctomy For Hirschsprung's Disease

Objective Congenital megacolon (Hirschsprung disease, HD) is one of common gastrointestinal tract malformation. Generally, postoperative results in the surgical management of HD appeared to be satisfactory gradually. Despite this reported good overall outcome, many studies showed higher than anticipated incidences of problems after surgery for HD. Patients with HD have a frequency of persistent fecal dysfunction and psychosocial problems. The wide variability of outcome were reported due to variations of age at operation, length of aganglionosis colon, the types of operations, and the time of follow-up, et al. This study is to explore postoperative fecal function of transanal endorectal pull-through (TREP)with partial internal sphincter myoctomy for HD.Methods Eighty-nine cases underwent transanal endorectal pull-through (TREP) with partial internal sphincter myoctomy in Provincial Hospital Affiliated to Shandong University Between 2001 and 2006. 42 cases were evaluated for bowel continence, development and results of anorectal manometry postoperatively. And the clinical manifestations were recorded in detail in the standard questionnaires with different postoperative time. Abdominal and anal examinations were routinely applied. Control group was made 18 cases without digestive diseases.Results 42 cases were classified into 3 groups, according to the standard quantitative clinical scoring systems. Postoperative anal function of 42 patients were good in 30 cases who have normal bowel habit, fair in 5 cases with minor continence related social problems and poor in 7 cases with marked limitations in social life. Postoperative complications included: durative constipation in 2, recurrent soiling in 6, enterocolitis in 4 and recurrent diarrhea in 2. Rectoanal inhibitory reflex (RAIR) was observed only 1 case. Postoperative anal rest pressure of poor group and control group was (35.8±10.1)mmHg and (61.4±19.0)mmHg respectively (P<0.05).Conclusion 1. Anorectal manometry study showed the anal rest pressure among good group, fair group and control group were not different. The anal rest pressure in poor group were significantly lower than that of control group(P< 0.05). Postoperative anal rest pressure may affected fecal function.2. Growth fair and common group were 31 cases and 11 cases respectively, according to Kaups' rate. Postoperative fecal function and growth are not visible differences in various age groups.3. Fecal functional disorder dropped off along with delay after surgery no matter of the different operative age. The longer of Postoperative time, the fewer of fecal dysfunctions.4. All cases divided into shorter than 35cm group and no shorter than 35cm group by the different length colon cutting in the operation. This study showed the longer length of cutting colon, the more fecal dysfunctions postoperatively in the same procedure.TREP with partial internal sphincter myoctomy was effective for HD, but it is important to prevent and treat the short-term postoperative complications. And anorectal manometry chould be an evaluating indicator for postoperative fecal function of HD.