Guidelines for the management of postoperative soiling in children with Hirschsprung disease

P Saadai; A F Trappey; A M Goldstein; R A Cowles; L De La Torre; M M Durham; E Y Huang; M A Levitt; K Rialon; M Rollins; D H Rothstein; J C Langer; American Pediatric Surgical Association Hirschsprung Disease Interest Group

doi:10.1007/s00383-019-04497-y

Guidelines for the management of postoperative soiling in children with Hirschsprung disease

Pediatr Surg Int. 2019 Aug;35(8):829-834. doi: 10.1007/s00383-019-04497-y. Epub 2019 Jun 14.

Authors

P Saadai^{1

2}, A F Trappey^{3

4}, A M Goldstein⁵, R A Cowles⁶, L De La Torre⁷, M M Durham⁸, E Y Huang⁹, M A Levitt¹⁰, K Rialon¹¹, M Rollins¹², D H Rothstein¹³, J C Langer¹¹; American Pediatric Surgical Association Hirschsprung Disease Interest Group

Affiliations

¹ Division of Pediatric Surgery, Department of Surgery, University of California, Davis, CA, USA. [email protected].
² Pediatric Colorectal Center, Shriners Hospitals for Children, Northern California, 2425 Stockton Blvd, Sacramento, CA, 95818, USA. [email protected].
³ Division of Pediatric Surgery, Department of Surgery, University of California, Davis, CA, USA.
⁴ Pediatric Colorectal Center, Shriners Hospitals for Children, Northern California, 2425 Stockton Blvd, Sacramento, CA, 95818, USA.
⁵ Department of Pediatric Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
⁶ Section of Pediatric Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, USA.
⁷ Colorectal Center for Children At Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
⁸ Division of Pediatric Surgery, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA, USA.
⁹ Department of Surgery and Pediatrics, The University of Tennessee Health Science Center, Memphis, TN, USA.
¹⁰ Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH, USA.
¹¹ Division of General and Thoracic Surgery, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Canada.
¹² Primary Children's Hospital, University of Utah School of Medicine, Salt Lake City, UT, USA.
¹³ Department of Pediatric Surgery, Women and Children's Hospital of Buffalo, Buffalo, NY, USA.

PMID: 31201486
DOI: 10.1007/s00383-019-04497-y

Abstract

Although most children with Hirschsprung disease ultimately achieve functional and comfortable stooling, some will experience a variety of problems after pull-through surgery. The most common problems include soiling, obstructive symptoms, enterocolitis, and failure to thrive. The purpose of this guideline is to present a rational approach to the management of postoperative soiling in children with Hirschsprung disease. The American Pediatric Surgical Association Hirschsprung Disease Interest Group engaged in a literature review and group discussions. Expert consensus was then used to summarize the current state of knowledge regarding causes, methods of diagnosis, and treatment approaches to children with soiling symptoms following pull-through for Hirschsprung disease. Causes of soiling after pull-through are broadly categorized as abnormalities in sensation, abnormalities in sphincter control, and "pseudo-incontinence." A stepwise algorithm for the diagnosis and management of soiling after a pull-through for Hirschsprung disease is presented; it is our hope that this rational approach will facilitate treatment and optimize outcomes.

Keywords: Bowel management; Hirschsprung disease; Incontinence; Pseudo-incontinence; Pull-through; Soiling.

Publication types

Review

MeSH terms

Algorithms*
Child
Digestive System Surgical Procedures / methods*
Fecal Incontinence / etiology
Fecal Incontinence / surgery*
Hirschsprung Disease / complications
Hirschsprung Disease / surgery*
Humans
Postoperative Complications / prevention & control*
Postoperative Period
Practice Guidelines as Topic*
Treatment Outcome