FACTORS AFFECTING POSTOPERATIVE FECAL SOILING IN HIRSCHSPRUNGS-DISEASE

We retrospectively assessed the factors that may contribute to fecal s oiling after surgery for Hirschsprung's disease. Fifty-eight patients underwent surgery for Hirschsprung's disease and returned for follow u p. The patients were divided into two groups based on the presence or absence of fecal soiling. The postoperative period, level of bowel pul led through, stool frequency, stool character, presence or absence of anorectal surgical complications, and manometric findings of the two g roups were compared. Forty-three patients (40 boys, 3 girls, mean age 9.5 yr) had soiling and 15 (10 boys, 5 girls, mean age 10.2 yr) did no t. Patients with soiling had significantly higher rates of anorectal s urgical complications (60% vs 7%), abnormal stool character (75% vs 7% ), stool frequency greater than three times per day (63% vs 20%), abse nce of rectoanal inhibitory reflex (33% vs 2%), and narrow anorectal p ressure gradient (60% vs 13%) than those without. The results of manom etric study suggested that a damaged internal sphincter or irritable n eorectum might have contributed to fecal soiling. In conclusion, altho ugh anorectal surgical complications might result in both irritable ne orectum and damaged internal sphincter, their effect on the neorectum (significantly increased rate of high resting rectal pressure) seemed to outweigh that on the internal sphincter. A competent anal sphincter and a less irritable neorectum after operation may therefore lower th e likelihood of fecal soiling.