Abstract
Aim: Surgery for Hirschsprung's disease generally results in a satisfactory outcome, but some patients continue to have persistent bowel dysfunction. The symptoms of obstruction after surgery for Hirschsprung's disease may result from non-relaxing internal anal sphincter. Nitric oxide (NO) has been identified as the chemical messenger mediating relaxation of the internal anal sphincter. Organic nitrates are degraded by cellular metabolism, liberating NO and exagenous application results in a relaxation response. The purpose of this study is to investigate the topical Nitric oxide application for obstructive symptoms after surgery for Hirschsprung's disease.Material and
Method: We reviewed application of topical NO on thirteen symptomatic children who were operated for Hirschsprung's disease. Thirteen patients were evaluated for anorectal manometric, functional and clinical outcomes. The symptoms included enterocolitis in eight and constipation in five patients. NO ointment was applied twice daily for six weeks in symptomatic patients and manometry was repeated.
Results: Anorectal manometric evaluation of thirteen patients has shown a non-relaxing internal anal sphinctere without reflex relaxation on applying distending pressure to the rectum. Marked improvement of symptoms were noted after 6 week application of topical NO and also maximum anal resting pressure (MARP) decreased significantly (34 % reduction). After ceasing the application of topical ointment, MARP increased again.
Conclusion: We conclude that impaired colonic peristaltism could pass the decreased internal anal sphinctere pressure after NO ointment application. Although non-relaxing anal sphinctere is not thought to be the causative reason for obstructive symptoms alone, relaxation of anal sphinctere may improve the symptoms causing a reversible chemical sphincterotomy. The symptomatic patients with Hirschprung's disease showing the signs of obstruction should be managed applying topical NO ointment
Keywords: Hirschsprung's disease, Nitric oxide
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