Clinical and manometric evaluation of postoperative fecal soiling in patients with Hirschsprung's disease

We examined the usefulness of manometry: as an indicator of fecal soiling a fter surgical correction of Hirschsprung's disease, and attempted to identi fy measures to alleviate this complication. Sequential clinical and manomet ric evaluations of postoperative fecal soiling were performed in 35 patient s (30 males, 5 females) with Hirschsprung's disease. The resting anal press ure (RAP), resting rectal pressure, and anorectal pressure gradient (ARPG) all decreased significantly from the preoperative values after corrective p ull-through surgery. This correlated well with the clinical change from pre operative obstipation to Frequent stool passage or soiling postoperatively. A total of 80% of the patients had mild or severe fecal soiling within 4 y ears after surgery, but only 40% had persistent symptoms thereafter. The ma nometric profile showed significant elevations in RAP and ARPG 4 years afte r surgery. Only five patients had positive conversion of rectoanal sphincte ric inhibitory reflex (RASIR) after surgery, and the presence of RASIR was not related to continence. Also, there was no difference in the manometric profile between patients with and without RASIR. However, patients without RASIR were prone to suffer from severe diarrhea or soiling on consuming spe cific foods or catching cold. In conclusion, anorectal manometry can be an objective tool for the evaluation of postoperative fecal soiling in patient s with Hirschsprung's disease. The low conversion rate of RASIR combined wi th hypersensitivity; of the bowel in patients with Hirschsprung's disease s uggests that some kind of enteric nervous system disorder might exist other than aganglionosis.