Post-operative anorectal manometry in children with Hirschsprung disease: A systematic review

Hannah M E Evans-Barns; Justina B Swannjo; Misel Trajanovska; Mark Safe; John M Hutson; Phil G Dinning; Sebastian K King

doi:10.1111/nmo.14311

Post-operative anorectal manometry in children with Hirschsprung disease: A systematic review

Neurogastroenterol Motil. 2022 Aug;34(8):e14311. doi: 10.1111/nmo.14311. Epub 2021 Dec 29.

Authors

Hannah M E Evans-Barns^{1

2

3}, Justina B Swannjo³, Misel Trajanovska^{1

2}, Mark Safe⁴, John M Hutson^{2

3

5}, Phil G Dinning⁶, Sebastian K King^{1

2

3}

Affiliations

¹ Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Victoria, Australia.
² Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
³ Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
⁴ Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, Melbourne, Victoria, Australia.
⁵ Department of Urology, The Royal Children's Hospital, Melbourne, Victoria, Australia.
⁶ Department of Surgery, College of Medicine and Public Health, The Flinders University and Flinders Medical Centre, Bedford Park, South Australia, Australia.

PMID: 34964199
DOI: 10.1111/nmo.14311

Abstract

Background: Hirschsprung disease is commonly encountered by pediatric surgeons. Despite advances in the surgical management, these children may experience symptoms of bowel dysfunction throughout adulthood. Anorectal manometry may be used to assess post-operative anorectal structure and function. This review aimed to consolidate and evaluate the literature pertaining to post-operative findings of anorectal manometry in children with Hirschsprung disease.

Purpose: (1) Synthesize the available data regarding anorectal motility patterns in children following repair of Hirschsprung disease. (2) Evaluate the reported anorectal manometry protocols.

Data sources: We performed a systematic review of four databases: Embase, MEDLINE, the Cochrane Library, and PubMed.

Study selection: This systematic review was performed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Studies reporting results of post-operative anorectal manometry in children with Hirschsprung disease were evaluated for inclusion.

Results: Twenty-three studies satisfied inclusion criteria, with a combined cohort of 939 patients. Post-operative anorectal manometry results were reported for 682 children. The majority of included studies were assessed as "poor quality." Disparate manometry protocols, heterogeneous cohorts, and lack of standardized outcome assessments introduced a risk of outcome reporting bias, limited the comparability of results, and impeded clinical translation of findings.

Conclusions: This systematic review demonstrated the lack of high-quality evidence underlying the current understanding of post-operative anorectal motility in children with HD. There was little consistency in reported manometry outcomes between studies. In future work, emphasis must be placed on the application of standardized manometry protocols, cohort reporting, and patient outcome assessments.

Keywords: Hirschsprung disease; anorectum; gastrointestinal motility; high-resolution manometry; manometry.

Publication types

Review
Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Anal Canal
Child
Hirschsprung Disease* / diagnosis
Hirschsprung Disease* / surgery
Humans
Manometry / methods
Postoperative Period
Rectum