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

• 影响指数: 2.003
• 发表时间: Aug 2019
• 来源期刊: Pediatr Surg Int
• DOI: 10.1007/s00383-019-04497-y
• PMID: 31201486
• 文章类型: Journal Article
• 中科院分区: Q3
• 方向: 医学
• 作者列表: Saadai P,Trappey AF,Goldstein AM,Cowles RA,De La Torre L,Durham MM,Huang EY,Levitt MA,Rialon K,Rollins M,Rothstein DH,Langer JC,

关键词: Bowel management; Hirschsprung disease; Incontinence; Pseudo-incontinence; Pull-through; Soiling

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

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.