Abstract
Background: Transanal irrigation (TAI) is employed for children with fecal incontinence, but it can present several problems which require a study of their outcomes among different pathologies and without a tailored work up. The aim of our study was to evaluate the effectiveness of an advanced protocol in order to tailor TAI, prevent complications, and evaluate outcomes. Methods: We included 70 patients (14 anorectal malformation, 12 Hirschsprung’s disease, 24 neurological impairment, 20 functional incontinence) submitted to a comprehensive protocol with Peristeen®: fecal score, volumetric enema, rectal ultrasound, anorectal 3D manometry, and diary for testing and parameter adjustment. Results: Among the patients, 62.9% needed adaptations to the parameters, mainly volume of irrigated water and number of puffs of balloon. These adaptations were positively correlated with pre-treatment manometric and enema data. In each group, the improvement of score was statistically significant in all cases (p 0.000); the main factor influencing the efficacy was the rate of sphincter anomalies. The ARM group had slower improvement than other groups, whereas functional patients had the best response. Conclusions: Our results showed that TAI should not be standardized for all patients, because each one has different peculiarities; evaluation of patients before TAI with rectal ultrasound, enema, and manometry allowed us to tailor the treatment, highlighting different outcomes among various pathologies, thus improving the efficacy.
Highlights
Severe constipation and fecal incontinence are often observed in pediatric patients with either functional or organic bowel dysfunction; the management of this complex group of patients can be difficult and the different treatments proposed so far—either invasive or not—have shown variable efficacy [1,2,3,4]
It is mandatory to consider that popularity of transanal bowel management technique is influenced by an important cultural aspect: in different part of the world, families may not accept the use of transanal therapies which might be considered as violating the child and so, it is important improve the efficacy of this procedure as much as possible in order to propose it to families as a valid instrument to improve their quality of life
Considering all the results described in our study, even though the small number of patients is insufficient to draw firm conclusions, we are strongly convinced of the need for a tailored Transanal irrigation (TAI) procedure, using an advanced protocol based on clinical score evaluation, diary, anorectal manometry, and volumetric enema
Summary
Severe constipation and fecal incontinence are often observed in pediatric patients with either functional or organic bowel dysfunction; the management of this complex group of patients can be difficult and the different treatments proposed so far—either invasive or not—have shown variable efficacy [1,2,3,4]. Despite the existence of valid but generic pediatric best practice [10], there are no series reporting on differentiated outcomes and comparisson among different pathologies Another important issue concerns the management of patients before starting treatment with TAI. Results: Among the patients, 62.9% needed adaptations to the parameters, mainly volume of irrigated water and number of puffs of balloon These adaptations were positively correlated with pre-treatment manometric and enema data. Conclusions: Our results showed that TAI should not be standardized for all patients, because each one has different peculiarities; evaluation of patients before TAI with rectal ultrasound, enema, and manometry allowed us to tailor the treatment, highlighting different outcomes among various pathologies, improving the efficacy
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