title: Defecation disorders in children after surgery for Hirschsprung disease.
abstract: OBJECTIVE
  The majority of children with Hirschsprung disease (HD) after corrective surgery (CS) develop protracted defecation disorders (DDs) such as constipation, fecal incontinence, and/or enterocolitis. The aim of this investigation was to determine the diagnoses, therapies, and long-term clinical outcomes using a systematic algorithm to address protracted DD in children with HD after CS.
  
  
  METHODS
  Retrospective review of children with HD after CS cared for using a systematic algorithm at a tertiary care center. Potential anatomic etiologies were evaluated for first. Clinical outcome was categorized into 4 groups based on symptom severity, time interval from last enterocolitis episode, laxative usage, and/or rectal therapies at the time of last follow-up.
  
  
  RESULTS
  Fifty-seven children were identified, of whom 51 (89.5%) had obstructive symptoms and/or enterocolitis and 6 (10.5%) had nonretentive fecal incontinence. Nonintractable constipation responsive to laxatives was identified in 10 (17.5%), colonic dysmotility in 4 (7.0%), nonrelaxing anal sphincter as a primary etiology in 22 (38.6%), bacterial overgrowth in 2 (3.5%), food intolerance in 2 (3.5%), and rapid transit in 2 (3.5%). Further surgical intervention was undertaken in 22 (38.6%), including 9 (15.8%) for residual aganglionosis. Mean follow-up was 41.4 ± 4.5 months. Clinical outcomes were excellent in 16 (28.1%), good in 22 (38.6%), fair in 1 (1.8%), and poor in 18 (31.6%). Children with enterocolitis were more likely to have an excellent or good clinical outcome.
  
  
  CONCLUSIONS
  The majority of children with HD and protracted DD after CS have a favorable long-term clinical outcome when following a systematic algorithm.
authors.affiliation: Center for Motility and Functional Gastrointestinal Disorders, Children's Hospital Boston, Boston, MA 02115, USA.
authors.forename: Bruno P
authors.initials: BP
authors.lastname: Chumpitazi
authors.forename: Samuel
authors.initials: S
authors.lastname: Nurko
mesh_terms: D000465:Algorithms; D001900:Boston / Q000453:epidemiology; D002648:Child; D003248:Constipation / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D003663:Decision Trees; D003672:Defecation; D004760:Enterocolitis / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D005242:Fecal Incontinence / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D006627:Hirschsprung Disease / Q000601:surgery*; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D008499:Medical Records; D010044:Outpatient Clinics, Hospital; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome