title: Anal endosonography and bowel function in patients undergoing different types of endorectal pull-through procedures for Hirschsprung disease.
abstract: BACKGROUND
  The reasons for fecal incontinence after surgery for Hirschsprung disease (HD) remain unclear. The aim of this study was to examine the anal sphincters by anal endosonography and manometry after transanal endorectal pull-through, with or without laparotomy or laparoscopy, in HD patients. Furthermore, we aimed to correlate these findings to bowel function.
  
  
  METHODS
  Fifty-two HD patients were followed after endorectal pull-through. Anal endosonography and manometry were performed without sedation at the age of 3 to 16 years.
  
  
  RESULTS
  Endosonographic internal anal sphincter (IAS) defects were found in 24/50 patients, more frequently after transanal than transabdominal procedures (69 vs. 19%, p=0.001). In a multiple variable logistic regression model, operative approach was the only significant predictor for IAS defects. Anal resting pressure (median 40mm Hg, range 15-120) was not correlated to presence of IAS defects. Daily fecal incontinence occurred more often in patients with IAS defects (54 vs. 25%, p=0.03).
  
  
  CONCLUSIONS
  Postoperative IAS defects were frequently detected and were associated with daily fecal incontinence. IAS defects occurred more often after solely transanal procedures. We propose that these surgical approaches are compared in a randomized controlled trial before solely transanal endorectal pull-through is performed as a routine procedure.
authors.affiliation: Oslo University Hospital, Department of Pediatric surgery, P.O. Box 4950 Nydalen, 0424 Oslo, Norway. Electronic address: kstensru@ous-hf.no.
authors.forename: Kjetil J
authors.initials: KJ
authors.lastname: Stensrud
authors.affiliation: Oslo University Hospital, Department of Pediatric surgery, P.O. Box 4950 Nydalen, 0424 Oslo, Norway; University of Oslo, Faculty of Medicine, P.O. Box 1078 Blidern, 0316 Oslo, Norway.
authors.forename: Ragnhild
authors.initials: R
authors.lastname: Emblem
authors.affiliation: Oslo University Hospital, Department of Pediatric surgery, P.O. Box 4950 Nydalen, 0424 Oslo, Norway; University of Oslo, Faculty of Medicine, P.O. Box 1078 Blidern, 0316 Oslo, Norway.
authors.forename: Kristin
authors.initials: K
authors.lastname: Bjørnland
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D019160:Endosonography; D005242:Fecal Incontinence / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D007813:Laparotomy; D016015:Logistic Models; D008297:Male; D008365:Manometry; D011183:Postoperative Complications / Q000175:diagnosis / Q000209:etiology*; D011446:Prospective Studies; D012007:Rectum / Q000601:surgery
keywords: Anal endosonography; Anal manometry; Anal sphincter; Hirschsprung disease; Postoperative fecal incontinence