Role of bulking agents in improving continence postoperatively in patients with Hirschsprung’s disease
Background: The bulking agents have provided an effective means of treating adults with internal sphincter (IS) incompetence. The damages to IS in pull‑through operation and in those who had hypermotile proximal bowel segments have increased the need for increasing the IS pressure. Materials and Methods: 35 children with fecal incontinence after pull‑through, who presented to our unit from January 2008 to February 2012, were enrolled in the study and investigated with endoanal sonography and anorectal manometry. The bulking agent was injected into the sub‑mucosal anal plane of IS. The assessments undertaken were clinical assessment of the functional score and anorectal manometery for 6-12 months. Data were analyzed with IBM SPSS version 21 using repeated measure analysis of variance (ANOVA). Friedman test was used for analyzing soilage score changes during the study. Results: Manometry readings before and 6 months after intervention were 21.8 ± 4.2 and 25.2 ± 4.7 mmH2O, respectively. High‑pressure zone area changed from 1.98 ± 0.63 to 2.8 ± 0.75 cm (P < 0.0001). B efore intervention, all the patients had complaints of soilage and complete incontinency. However, after intervention and 6-12 month follow‑up, nearly 60% of patients were continent without significant soilage. However, there was a significant improvement in the overall continence grading scale scores post bulking from baseline to 6-12 months, but no change in the mean squeeze pressures at any time interval. Conclusion: Bulking of internal anal sphincter defects causes an improvement in fecal continence and the function.