الفهرس 
ANATOMY OF ANAL CANALOnly 14 pages are availabe for public view
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Abstract
H
irschsprung (HD) disease is a relatively common neonatal developmental disorder of the enteric nervous system. it is characterized by the absence of ganglion cells in the myenteric and submucosal plexuses of the distal intestine. This results in absent peristalsis in the affected bowel, and the development of a functional intestinal obstruction. The pathogenesis and genetic basis of the disease is yet unclear.
Here comes the importance of outcome evaluation and the tools used in this process in order to audit the surgical procedure used in those patients, to serve as common language between surgeons to compare and share surgical outcome, and to improve the overall surgical practice which will be reflected on a better quality of life for those patients.
The surgical management of Hirschsprung’s disease (HD) has developed, from full thickness rectosigmoid dissection (Swenson and Bill), an endorectal dissection (Soave)and retro rectal pouch procedure (Duhamel), to more recently a primary repair that can be done transanally.
Complications can be classified as either early (weeks to months) or late (months to years). Early postoperative complications include anastomotic leak and cuff abscess, bowel obstruction, perineal excoriation, stoma complications, and wound infection. Late complications include bowel obstruction, constipation, enterocolitis, incontinence, and stricture. There is some overlap between the early and late complications.
The aims of this study to highlight the post-operative late complications of the patients who had been diagnosed and operated as HD including enterocolitis and faecal incontinence. In addition, we will focus on the fecal incontinence using Krickenbeck score
This is a Retrospective study will be conducted on children with HD operated, who were operated on at Benha children hospital with endorectal pull-through at the last seven years for each patient, the following was done prior to the surgical procedure:
• Full clinical history taking.
• Full physical examination.
• Laboratory investigations.
• Radiological examination.
• Rectal biopsy.
Our results showed that;
• As regards enterocolitis was present in 16 patients (80%) and absent in 4 patients (20%).Patients with recurrent attacks of one to three times of enterocolitis was 12 patients (60%), patients with four to six times was 3 patients (15%) and patients with more than six times was 1 patient (5%).
• As regards voluntary bowel movements most of the cases (90%) had voluntary bowel movements.
• As regards Soiling was, absent in 5 patients (25%) and present in 15 patients (75%) and divided in two grads, grade one in 12 patients (60%) and grade two in 3 patients (15%).
• As regards Constipation was, absent in 4 patients (20%) and present in 16 patients (60%) and divided in two grads, grade one in 10 patients (50%) and grade two in 6 patients (30%).
The following conclusions can be drawn based upon the present work:
Functional assessment of HD patients is essential to detect and properly manage defecatory dysfunction early to allow the patients to be socially continent and to avoid negative psychological and social sequelae.
Clinical scoring using krickenbeck scores is a good subjective way to assess postoperative functional outcome, easy to understand and perform but still these scores lacks validation.
Fecal incontinence after operative management of Hirschsprung’s disease represents a serious problem. Poor surgical technique may be a contributing factor in some of our cases and older age of the patients is also contributing factor.
The majority of long-term follow-up studies have concentrated only on the functional outcome. Although this is an important consideration, little is known about the quality of life in patients after surgical treatment for Hirschsprung’s disease.