POSTOPERATIVE FECAL INCONTINENCE IN HIRSCHSPRUNG’S DISEASE – TECHNICAL SURGICAL ERROR OR AN INEVITABLE COMPLICATION?

D. A. Iozsa, M. Ivanov, R. I. Spătaru, D. Șerban

Abstract: Background. Hirschsprung’s disease is a congenital disorder of the enteric nervous system which determines functional bowel obstruction because of the absence of the ganglion cells in the muscular and submucosal layer. Postoperative fecal incontinence is a rare complication with life long implications. Surgical preventive measures and clinical protocols can prevent it and improve quality of care.
Objectives. The study evaluates the types and causes of postoperative fecal incontinence in our patients with Hirschsprung’s disease.
Methods. This is retrospective study, single surgical team experience. The study included all patients operated for Hirschsprung’s disease who presented for fecal incontinence and older than 3 years (age for toilet training). We examined the patients’ surgical history (type of surgery, length of resected colon), evaluated the aspect of the colon with contrast enema and performed rectal examination under anesthesia to evaluate the integrity of the anal canal.
Results. Three patients had true fecal incontinence with disruption of the anal sphincters regardless of the retained colon length. Four patients with total aganglionosis had integral anal canal with short intestine but could obtain social continence with bowel management. The rest of the patients (14 patients) had false incontinence (encompresis) and were managed with laxatives and stool bulking agents for minimum 6 months.
Conclusions. Postoperative fecal incontinence in Hirschsprung’s patients can and must be prevented. Management of these patients should be done following specific guidelines and in centers that can provide multidisciplinary services.
Keywords: Hirschsprung’s disease, fecal incontinence, anal canal, bowel management, clinical protocols