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Hirschsprung Hastalıklı Olgularda Düzeltici Ameliyat Sonrası Klinik Seyrin Anorektal Manometre Tetkiki İle Değerlendirilmesi

Year 2007, Volume: 1 Issue: 1, 28 - 32, 01.06.2007

Abstract

Amaç: Hirschsprung hastalıklı olgularda cerrahi tedavi ile genellikle iyi sonuçlar alınırken bir grup hastada barsak disfonksiyonunun devam ettiği gözlenir. Çocukluk çağı boyunca Hirschsprung hastalığı nedeni ile opere edilen olgularda klinik düzelmenin olduğu rapor edilmektedir. Bu klinik düzelmenin nedeni açık değildir. Çalışmamızda Hirschsprung hastalığı nedeni ile definitif ameliyatı yapılmış olan olgularda periyodik olarak yapılan anorektal manometri incelemesi ile yaşla beraber anorektal fonksiyonların değişiminin değerlendirilmesi amaçlandı.Materyal Metod: Periyodik anorektal manometre değerlendirmesi yapılan, Hirschsprung hastalığı nedeni ile opere edilmiş olan 25 erkek, beş kız toplam 30 olgu değerlendirildi. Rektoanal inhibitör refleksi (RAİR) ile maksimum anal istirahat basınç (MAİB) ölçümleri değerlendirmeye alındı. Fonksiyonel seyir düzenlenen anketler ile belirlendiBulgular: Hastaların ilk değerlendirilmelerinde altı olguda enterokolit (%20), yedi olguda (%23) ise kabızlık yakınmalarının olduğu belirlendi. Anorektal inhibitör refleks tüm olgularda anormal olarak değerlendirildi. Ameliyat sonrası manometre ölçümlerinde maksimum anal istirahat basıncı değerlendirmeleri karşılaştırıldığında değişik yaş grupları arasında anlamlı fark bulunmadı. Klinik izlem esnasında barsak fonksiyonunun kendiliğinden düzelerek, disfonksiyonel yakınmaların %43' den %15' e gerilediği belirlendi.Tartışma ve Sonuç: Hirschsprung hastalığı nedeni ile opere edilen olguların çoğunda ameliyat sonrası dönemde barsak fonksiyonlarının bozuk olduğu görülmektedir. İzlem esnasında kabızlık ve enterokolit yakınmaları özellikle beş yaşından sonra gerilemektedir. Hirschsprung hastalığında tedavi sonrası anorektal bölgenin manometrik değerlendirmesinde belirgin bir değişiklik olmadan yaşla beraber klinik iyileşmenin olması barsak motilitesinin düzenlenmesi, karın kaslarının ve eksternal anal sfinkterin istemli olarak kullanılmasının öğrenilmesi gibi farklı mekanizmaların iyileşmede rol oynayabileceğini düşündürmektedir.

References

  • Marty TL, Seo T, Matlak ME Sullivan JJ, Black Re, Johnson DG. Gastrointestinal function after surgical correction of Hirschsprung's disease: Long term follow-up in 135 patients. J Pediatr Surg 1995; 30: 655-658.
  • Bai Y, Chen H, Hao J, Huang Y, Wang W. Long term outcome and quality of life after the Swenson procedure for Hirschsprung's disease. J Pediatr Surg 2002; 37: 639-642.
  • Heikkinen M, Rintala R, Luukkonen P. Long term anal sphincter performance after surgery for Hirschsprung's disease. J Pediatr Surg 1997; 32: 1443-1446.
  • Heij HA, de Vries X, Bremer I, Ekkelkamp S, Vos A. Long term anorectal function after Duhamel operation for Hirschsprung's disease. J Pediatr Surg 1995; 30: 430-432.
  • Sherman JO, Snyder ME, Weitzman JJ, Jona JZ, Gillis DA, O'Donnell B, Cacassonne M, Swenson O. A 40-year multinational retrospectie study of 880 swenson proceduces. J Pediatr surg 1989; 24: 833-838
  • Moore SW, Millar AJ, Cywes S. Long term Clinical manometric and histological evaluation of obstructive symptoms in the posoperative Hirschsprung's patient. J Pediatr Surg 1994; 29: 106-111.
  • Tariq GM, Brereton RJ, Wright VM. Complications of endorectal pull-through for Hirschsprung's disease. J Pediatr Surg 1991; 26: 1202 -1206.
  • Fortuna RS, Weber TR, Tracy TF, Jr Silen ML, Cradock TV. Critical analysis of the operative treatment of Hirschsprung's disease. Arch Surg 1996; 131: 520-524
  • Yanchar NL, Soucy P. Long-term outcome after Hirschsprung's disease: patients' perspectives. J Pediatr Surg 1999; 34: 1152-1160.
  • Mishalany HG, Woolley MM. Postoperative functional and manometric evaluation of patients with Hirschsprung's disease. J Pediatr Surg 1987; 22: 443-446.
  • Di Lorenzo C, Solzi GF, Flores AF, Schwankovsky L, Hyman PE. Colonic motility after surgery for Hirschsprung's disease. Am J Gastroenterol 2000; 95: 1759-1764.
  • Reding R, Je Ville de Goyet, Gosseye S, Clapuyt P, Sokal E, Buts JP, Gibbs P, Otte JB. Hirschsprung's disease: a 20- year experience. J Pediatr Surg 1997; 32: 1221-1225.
  • Keshtgar AS, Ward HC, Clayden GS, Je Sousa NM. Investigations for incontinence and constipation after surgery for Hirschsprung's disease in children. Pediatr Surg Int 2003; 19: 4-8.
  • Farrugia MK, Alexander N, Clarke S, Nash R, Nicholls EA, Holmes K. Does transitional zone pull-through in Hirschsprung's disease imply a poor prognosis? J Pediatr Surg 2003; 38: 1766-1769.
  • Loening-Baucke V. Constipation in early childhood: patients characteristics, treatment, and long term follow up. Gut 1993; 34: 1400 -1404.
  • Tiryaki T, Demirbag S, Atayurt H, Cetinkurt S. Topıcal Nitric Oxide Treatment after pull through operations for Hirschsprung's Disease. J Pediatr Gastroenterol Nutr 2005; 40: 390-392.
  • Miele E, Tozzi A, Staiano A, Toraldo C, Esposito C, Clouse RE. Persistence of abnormal gastrointestinal motility after operation for Hirschsprung's disease. Am J Gastroenterol 2000; 95: 1226-1230.
  • Murphy MS. Achievement of voluntary control. In: Walker AW, Durie PR, Hamilton JR, et al eds. Pediatric Gastrointestinal Disease: Pathophysiology, Diagnosis, Management. Philadelphia BC Decker Inc. 1991: 95-96.

EVALUATION OF THE CLINICAL OUTCOME WITH ANORECTAL MANOMETRIC MEASUREMENTS AFTER DEFINITIVE SURGERY FOR HIRSCHSPRUNG'S DISEASE

Year 2007, Volume: 1 Issue: 1, 28 - 32, 01.06.2007

Abstract

Aim: Surgery for Hirschsprung's disease (HD) generally results in a satisfactory outcome, but some patients continue to have persistent bowel dysfunction. During childhood, progressive clinical improvement in patients operated for HD has been reported. The reason of the functional improvement in these patients is not clear. The aim of this investigation is to evaluate anorectal function periodically after definitive surgery for Hirschsprung's disease by anorectal manometry and compare the clinical improvement with manometric results.Materials and Methods: We evaluated (25 males, 5 females) 30 patients who had been operated for Hirschsprung's disease and evaluated with periodical anorectal manometry. Anorectal inhibitory reflex and maximum anal resting pressure were monitored. Functional outcomes were determined by a questionnaire. Results: Postoperative enterocolitis was seen in six patients (20%) and constipation was reported as a side effect in seven (23%) of the children in the first postoperative evaluation. Anorectal inhibitory reflex was abnormal in all of the patients. The postoperative anal resting pressure was not statistically different among patients in different ages groups. We found a spontanous improvement in bowel function from 43% to 15% within the follow-up period.Conclusion: The results of our study show that the majority of the patients have impaired bowel functions. On follow-up symptoms of constipation and enterocolitis had decreased significantly after five years old age. The extent of improvement was simply related to age whereas all the other anorectal manometric values did not change. In spite of abnormal anorectal manometry colonic motility, voluntary straining of the abdominal muscle and relaxation of the external sphincter keep the patients at recovery

References

  • Marty TL, Seo T, Matlak ME Sullivan JJ, Black Re, Johnson DG. Gastrointestinal function after surgical correction of Hirschsprung's disease: Long term follow-up in 135 patients. J Pediatr Surg 1995; 30: 655-658.
  • Bai Y, Chen H, Hao J, Huang Y, Wang W. Long term outcome and quality of life after the Swenson procedure for Hirschsprung's disease. J Pediatr Surg 2002; 37: 639-642.
  • Heikkinen M, Rintala R, Luukkonen P. Long term anal sphincter performance after surgery for Hirschsprung's disease. J Pediatr Surg 1997; 32: 1443-1446.
  • Heij HA, de Vries X, Bremer I, Ekkelkamp S, Vos A. Long term anorectal function after Duhamel operation for Hirschsprung's disease. J Pediatr Surg 1995; 30: 430-432.
  • Sherman JO, Snyder ME, Weitzman JJ, Jona JZ, Gillis DA, O'Donnell B, Cacassonne M, Swenson O. A 40-year multinational retrospectie study of 880 swenson proceduces. J Pediatr surg 1989; 24: 833-838
  • Moore SW, Millar AJ, Cywes S. Long term Clinical manometric and histological evaluation of obstructive symptoms in the posoperative Hirschsprung's patient. J Pediatr Surg 1994; 29: 106-111.
  • Tariq GM, Brereton RJ, Wright VM. Complications of endorectal pull-through for Hirschsprung's disease. J Pediatr Surg 1991; 26: 1202 -1206.
  • Fortuna RS, Weber TR, Tracy TF, Jr Silen ML, Cradock TV. Critical analysis of the operative treatment of Hirschsprung's disease. Arch Surg 1996; 131: 520-524
  • Yanchar NL, Soucy P. Long-term outcome after Hirschsprung's disease: patients' perspectives. J Pediatr Surg 1999; 34: 1152-1160.
  • Mishalany HG, Woolley MM. Postoperative functional and manometric evaluation of patients with Hirschsprung's disease. J Pediatr Surg 1987; 22: 443-446.
  • Di Lorenzo C, Solzi GF, Flores AF, Schwankovsky L, Hyman PE. Colonic motility after surgery for Hirschsprung's disease. Am J Gastroenterol 2000; 95: 1759-1764.
  • Reding R, Je Ville de Goyet, Gosseye S, Clapuyt P, Sokal E, Buts JP, Gibbs P, Otte JB. Hirschsprung's disease: a 20- year experience. J Pediatr Surg 1997; 32: 1221-1225.
  • Keshtgar AS, Ward HC, Clayden GS, Je Sousa NM. Investigations for incontinence and constipation after surgery for Hirschsprung's disease in children. Pediatr Surg Int 2003; 19: 4-8.
  • Farrugia MK, Alexander N, Clarke S, Nash R, Nicholls EA, Holmes K. Does transitional zone pull-through in Hirschsprung's disease imply a poor prognosis? J Pediatr Surg 2003; 38: 1766-1769.
  • Loening-Baucke V. Constipation in early childhood: patients characteristics, treatment, and long term follow up. Gut 1993; 34: 1400 -1404.
  • Tiryaki T, Demirbag S, Atayurt H, Cetinkurt S. Topıcal Nitric Oxide Treatment after pull through operations for Hirschsprung's Disease. J Pediatr Gastroenterol Nutr 2005; 40: 390-392.
  • Miele E, Tozzi A, Staiano A, Toraldo C, Esposito C, Clouse RE. Persistence of abnormal gastrointestinal motility after operation for Hirschsprung's disease. Am J Gastroenterol 2000; 95: 1226-1230.
  • Murphy MS. Achievement of voluntary control. In: Walker AW, Durie PR, Hamilton JR, et al eds. Pediatric Gastrointestinal Disease: Pathophysiology, Diagnosis, Management. Philadelphia BC Decker Inc. 1991: 95-96.
There are 18 citations in total.

Details

Other ID JA74FH83BS
Journal Section Research Article
Authors

Tuğrul Tiryaki This is me

Emrah Şenel This is me

Fatih Akbıyık This is me

Ervin Mambet This is me

Ziya Livanelioğlu This is me

Halil Atayurt This is me

Publication Date June 1, 2007
Submission Date June 1, 2007
Published in Issue Year 2007 Volume: 1 Issue: 1

Cite

Vancouver Tiryaki T, Şenel E, Akbıyık F, Mambet E, Livanelioğlu Z, Atayurt H. EVALUATION OF THE CLINICAL OUTCOME WITH ANORECTAL MANOMETRIC MEASUREMENTS AFTER DEFINITIVE SURGERY FOR HIRSCHSPRUNG’S DISEASE. Türkiye Çocuk Hast Derg. 2007;1(1):28-32.


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