Post-operative anal Sphincteric Study by Anorectal Manometer after Duhamel's Procedure for Hirschsprung's Disease

Background The purpose of this study is to describe the anal sphincteric function after Duhamel's operation by anomanometer, a versatile instrument, portable and easy to use. It has been used for assessment of continence after surgery of Hirschsprung's disease in children. The measurement of the resting anal pressure [ARP], maximum anal pressure [AMP] and Mean pressure provides the criteria upon which it is possible to quantify continence after surgical correction. of Hirschsprung's disease. The anomanometer records the biphasic response of the sphincters to rectal distension in normal children and the lack of the relaxation phase in Hirschsprung's disease, thus providing a convenient and simple method of diagnosis Material and Methods Total 27 patients of Hirschsprung's disease were taken for manometric study postoperatively after Duhamel's procedure. These patients were representative of the whole group of patients in terms of age, continence outcome, extent of the disease, this group consisted of 25 male and 2 female children. The mean age at the time of operation was 8 yrs. The disease had been confined to the rectosigmoid colon in 25 patients and extended to the descending colon in 1 patient. One patient had total colonic Hirschsprung's disease. Mean follow-up time after the operation was 3 yrs. Ten healthy children 8 yr [range 5-10] who had normal anorectal function constituted the control group. Results and Conclusion The post operative anal sphincteric function was accessed by anorectal manometric study which was suboptimal than control group. The lower resting pressures are caused partially by internal anal sphincter mayotomy performed during the pull-through procedure, when the septum between the rectum and ganglionic segment is resected, and partly by the anal dilation performed during the procedure