TÇCD 2011 29. National Pediatric Surgery Congress and 27. National Congress of The Egyptian Pediatric Surgical Association

Background:There is a growing acceptance of one-stage primary transanal pullthrough procedure for treatment of children with Hirschsprung Disease specially neonates to reduce the risk of abdominal surgery and its postoperative morbidity. The purpose of this study was to evaluate the anatomical and physiological status of the ano-rectum and the related neuromuscular complex in children with postoperative incontinence.Patients & Methods: 31 patients with incontinence after at least six months postoperative were subjected to evaluation by anorectal manometery, endoanal ultrasound, needle EMG and barium enema. Informed consent from parents of each child and acceptance of the ethical committee for medical research in the institute was obtained Results: Anorectal manometery showed weak resting pressure in 11 patients, weak squeezing pressure in 17 and failure to maintain squeezing in 7 of the 14 with good squeeze. Sensation was absent in 18, induced by volume higher than normal in 7 and within normal references in 6 patients. The Rectoanal inhibitory reflex was absent in 26 and weak in the remaining patients. Endoanal ultrasound revealed injury to either internal or external sphincters in all cases. Deficient sensation and nerve conduction were encountered by EMG in 15 children. Colonic dilatation was only present in 2 cases. Discussion: Despite the safety and short learning curve, transanal pullthrough seems to present a considerable risk to the state of continence and needs to be revised to decide upon the chances of improving the outcome.

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