J Neurogastroenterol Motil  
Interest of Anorectal Manometry During Long-term Follow-up of Patients Operated on for Hirschsprung’s Disease
Viet Q Tran,1,2* Tania Mahler,3 Patrick Bontems,3 Dinh Q Truong,1 Annie Robert,4 Philippe Goyens,5 and Henri Steyaert2
1Department of Pediatric Surgery, City Children’s Hospital, Ho Chi Minh City, Vietnam; Departments of 2Pediatric Surgery and 3Gastroenterology, Hôpital Universitaire des Enfants Reine Fabiola - Université Libre de Bruxelles (ULB), Brussels, Belgium; 4Faculté de santé publique, Institut de Recherche Expérimentale et Clinique (IREC), Pôle de recherche EPID Epidémiologie et Biostatistique - Université catholique de Louvain (UCL), Brussels, Belgium; and 5Laboratory of Pediatrics, Université Libre de Bruxelles (ULB), Brussels, Belgium
Correspondence to: Viet Q Tran, MD
Department of Pediatric Surgery, Hôpital Universitaire des Enfants Reine Fabiola - Université Libre de Bruxelles (ULB), Avenue Jean-Joseph Crocq 15 1020 Brussels, Belgium
Tel: +84-909-490-527, E-mail: dr.tranquocviet@gmail.com
Received: February 15, 2017; Revised: May 25, 2017; Accepted: July 12, 2017; Published online: November 25, 2017.
© The Korean Society of Neurogastroenterology and Motility. All rights reserved.

cc This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background/Aims
Although many advances in the management of Hirschsprung’s disease have recently been achieved, postoperative outcomes of these patients remain difficult in a non-negligible number of cases. Therefore, this study aims at investigating characteristics of anorectal manometry and its relationship with postoperative outcomes during long-term follow-up in Hirschsprung patients.
Methods
Patients over 4 years of age operated on for Hirschsprung’s disease were interviewed to complete detailed questionnaires on bowel function. The patients who consented to undergo an anorectal manometry during follow-up were enrolled in this study. We investigated their clinical characteristics, manometric findings, and their postoperative bowel function.
Results
Nineteen patients out of 53 patients (35.8%) were enrolled, 68.0% who were male. Mean age of patients at manometry was 11.3 ± 6.3 years. Twelve out of 19 patients (63.2%) were incontinent. The mean anal resting pressures of incontinent patients were significantly lower than continent patients (47 ± 12 mmHg versus 63 ± 11 mmHg, P 〈 0.05, t test). Due to neurological impairment, only 11 patients (58.0%) were able to perform a complete manometry. A dyssynergic defecation was found in 4 patients during strain tests. Maximum tolerated volume of the incontinent patients was significantly lower than that of the continent patients (97 ± 67 mL versus 181 ± 74 mL, P 〈 0.05, t test).
Conclusion
Anorectal manometry is an objective method providing useful information that could guide a more adapted management in patients with defecation disorders after Hirschsprung’s disease operation.
Keywords: Defecation; Follow-up studies; Hirschsprung disease; Manometry; Postoperative period


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