Topical application of isosorbide dinitrate in patients with persistent constipation after pull-throught surgery for Hirschsprung's disease

Aims: The aim of this study was to evaluate the anal manometric changes and the clinical effects after topical application of isosorbide dinitrate (ISDN) in patients with persistent constipation after pull-through surgery for Hirschsprung's disease (HD). Methods: We studied 3 children (2 males and 1 female), aged 2, 3 and 5 years respectively, who had undergone the Soave-Boley surgical procedure for HD and who suffered from persistent constipation after operation. We performed a pre- and postoperative anorectal manometry study and we applied ISDN paste (1 mg/kg two times daily) in the anal region for three weeks. All patients were followed-up and re-evaluated at 1,3, and 6 months. Results: All patients showed an improvement of symptoms, with an average of 4 spontaneous evacuations per week. Prior to the topical treatment, the medium pressure was 115.6 mmHg (range 102-130 mmHg), the maximum pressure was 160 mmHg (range 145-175 mmHg), and the medium length of the high pressure zone was 1.8cm (range 1.5-2.0 cm). At the 6 month follow-up, the medium pressure was 57.3 mmHg (range 52-61 mmHg, a decrease of 54.4%), the maximum pressure was 98 mmHg (range 88-107 mmHg; a decrease of 38.7%), and the medium length of the high pressure zone was 1.6 cm (range 1.4-1.8 cm; a decrease of 11.1 %). Conclusions: Topical treatment with ISDN is a valid therapeutic alternative to an anal myotomy in patients with persistent constipation after pull-through surgery for HD. However, a greater number of cases and a longer follow-up are necessary to confirm the validity of our experience. © Georg Thieme Verlag KG Stuttgart New York.