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Victoria E Claydon - One of the best experts on this subject based on the ideXlab platform.

  • clinical recommendations for use of lidocaine lubricant during Bowel care after spinal cord injury prolong care routines and worsen autonomic dysreflexia results from a randomised clinical trial
    Spinal Cord, 2020
    Co-Authors: Jessica A Inskip, Veraellen M Lucci, Maureen S Mcgrath, Rhonda Willms, Shirromi Sarveswaran, Victoria E Claydon
    Abstract:

    STUDY DESIGN Clinical trial. OBJECTIVE Spinal cord injury (SCI) impacts autonomic function and Bowel Management. Bowel care is a potential trigger for autonomic dysreflexia (AD; paroxysmal hypertension elicited by sensory stimuli below the level of lesion). AD can be life threatening so strategies to minimise AD are prioritised after SCI. Lidocaine lubricant is recommended during Bowel care with the rationale to minimise the sensory stimulus, reducing AD. The objective of this study was to assess whether lidocaine lubricant (Xylocaine 2%) ameliorates AD during at-home Bowel care compared with standard lubricant (placebo). SETTING Community. METHOD Participants (n = 13; age 44.0 ± 3.3 years) with high-level SCI (C3-T4) performed their normal at-home Bowel care on two days, each time using a different lubricant, with continuous non-invasive cardiovascular monitoring. Injury to spinal autonomic (sympathetic) nerves was determined from low-frequency systolic arterial pressure (LF SAP) variability. RESULTS Participants displayed reduced autonomic function (LF SAP 3.02 ± 0.84 mmHg2), suggesting impaired autonomic control. Bowel care duration was increased with lidocaine (79.1 ± 10.0 min) compared to placebo (57.7 ± 6.3 min; p = 0.018). All participants experienced AD on both days, but maximum SAP was higher with lidocaine (214.3 ± 10.5 mmHg) than placebo (196.7 ± 10.0 mmHg; p = 0.046). Overall, SAP was higher for longer with lidocaine (6.5 × 105 ± 0.9 × 105 mmHg • beat) than placebo (4.4 × 105 ± 0.6 × 105 mmHg • beat; p = 0.018) indicating a higher burden of AD. Heart rate and rhythm disturbances were increased during AD, particularly with lidocaine use. CONCLUSIONS At-home Bowel care was a potent trigger for AD. Our findings contradict recommendations for lidocaine use during Bowel care, suggesting that anaesthetic lubricants impair reflex Bowel emptying, resulting in longer care routines with an increased burden of AD.

  • a community perspective on Bowel Management and quality of life after spinal cord injury the influence of autonomic dysreflexia
    Journal of Neurotrauma, 2017
    Co-Authors: Jessica A Inskip, Veraellen M Lucci, Maureen S Mcgrath, Rhonda Willms, Victoria E Claydon
    Abstract:

    Abstract Autonomic dysfunction is common in individuals with spinal cord injury (SCI) and leads to numerous abnormalities, including profound cardiovascular and Bowel dysfunction. In those with high-level lesions, Bowel Management is a common trigger for autonomic dysreflexia (AD; hypertension provoked by sensory stimuli below the injury level). Improving Bowel care is integral for enhancing quality of life (QoL). We aimed to describe the relationships between Bowel care, AD, and QoL in individuals with SCI. We performed an online community survey of individuals with SCI. Those with injury at or above T7 were considered at risk for AD. Responses were received from 287 individuals with SCI (injury levels C1-sacral and average duration of injury 17.1 ± 12.9 [standard deviation] years). Survey completion rate was 73% (n = 210). Bowel Management was a problem for 78%: it interfered with personal relationships (60%) and prevented staying (62%) and working (41%) away from home. The normal Bowel care duration wa...

Soren Laurberg - One of the best experts on this subject based on the ideXlab platform.

  • autonomic dysreflexia during Bowel evacuation procedures and bladder filling in subjects with spinal cord injury
    Spinal Cord, 2014
    Co-Authors: P M Faaborg, Soren Laurberg, Andrei V Krassioukov, P Christensen, E Frandsen, Klaus Krogh
    Abstract:

    Randomized, controlled clinical trial. Bladder and Bowel Management may cause serious autonomic dysreflexia (AD) in subjects with high spinal cord injury (SCI). We aimed at investigating autonomic responses to digital rectal evacuation (DE), transanal irrigation (TAI) with 500 ml and filling cystometry (FC) in SCI. Aarhus University Hospital, Denmark. Eight subjects with SCI (AIS A) at or above T6 (high SCI) and a previous history of AD were compared with three subjects with SCI (AIS A) between T10 and L2 (low SCI). In randomized order, DE, TAI and FC were performed. AD was defined as an acute rise in systolic blood pressure (sBP) of ⩾30 mm Hg above baseline. Blood levels of norepinephrine and epinephrine were determined before and shortly after the procedures. During all three procedures, AD occurred in all patients with high SCI but not in those with low SCI. In high SCI subjects, DE increased median sBP from 127 (range: 86–154) to 188 (range: 140–206) mm Hg (P<0.02), TAI from 126 (range: 91–146) to 163 (range: 130–188) mm Hg (P<0.02) and FC from 125 (range: 106–149) to 200 (range: 179–220) mm Hg (P<0.01). The sBP increase was lower during TAI than during DE (P<0.05) or FC (P<0.02). In high SCI subjects, the blood levels of norepinephrine, but not those of epinephrine, increased significantly during all three stimuli (all P<0.05). Bowel and bladder Management caused AD in high SCI. The response is less severe during TAI than during FC or DE.

  • a randomized controlled trial of transanal irrigation versus conservative Bowel Management in spinal cord injured patients
    Gastroenterology, 2006
    Co-Authors: Peter Christensen, G Bazzocchi, Maureen Coggrave, Rainer Abel, Claes Hultling, Klaus Krogh, S Media, Soren Laurberg
    Abstract:

    Background & Aims: Bowel dysfunction in patients with spinal cord injury often causes constipation, fecal incontinence, or a combination of both with a significant impact on quality of life. Transanal irrigation improves Bowel function in selected patients. However, controlled trials of different Bowel Management regimens are lacking. The aim of the present study was to compare transanal irrigation with conservative Bowel Management (best supportive Bowel care without irrigation). Methods: In a prospective, randomized, controlled, multicenter trial involving 5 specialized European spinal cord injury centers, 87 patients with spinal cord injury with neurogenic Bowel dysfunction were randomly assigned to either transanal irrigation (42 patients) or conservative Bowel Management (45 patients) for a 10-week trial period. Results: Comparing transanal irrigation with conservative Bowel Management at termination of the study, the mean (SD) scores were as follows: Cleveland Clinic constipation scoring system (range, 0–30, 30=severe symptoms) was 10.3 (4.4) versus 13.2 (3.4) ( P = .0016), St. Mark's fecal incontinence grading system (range, 0–24, 24=severe symptoms) was 5.0 (4.6) versus 7.3 (4.0) ( P = .015), and the Neurogenic Bowel Dysfunction Score (range, 0–47, 47=severe symptoms) was 10.4 (6.8) versus 13.3 (6.4) ( P = .048). The modified American Society of Colorectal Surgeon fecal incontinence scores (for each subscale, range is 0–4, 4=high quality of life) were: lifestyle 3.0 (0.7) versus 2.8 (0.8) ( P = .13), coping/behavior 2.8 (0.8) versus 2.4 (0.7) ( P = .013), depression/self perception 3.0 (0.8) versus 2.7 (0.8) ( P = .055), and embarrassment 3.2 (0.8) versus 2.8 (0.9) ( P = .024). Conclusions: Compared with conservative Bowel Management, transanal irrigation improves constipation, fecal incontinence, and symptom-related quality of life.

Andrei V Krassioukov - One of the best experts on this subject based on the ideXlab platform.

  • epidural spinal cord stimulation acutely modulates lower urinary tract and Bowel function following spinal cord injury a case report
    Frontiers in Physiology, 2018
    Co-Authors: Matthias Walter, Amanda H X Lee, Alex Kavanagh, Aaron A Phillips, Andrei V Krassioukov
    Abstract:

    Regaining control of autonomic functions such as those of the cardiovascular system, lower urinary tract and Bowel, rank among the most important health priorities for individuals living with spinal cord injury (SCI). Recently our research provided evidence that epidural spinal cord stimulation (ESCS) could acutely modulate autonomic circuits responsible for cardiovascular function after SCI. This finding raised the question of whether ESCS can be used to modulate autonomic circuits involved in lower urinary tract and Bowel control after SCI. We present the case of a 32-year-old man with a chronic motor-complete SCI (American Spinal injury Association Impairment Scale B) at the 5th cervical spinal segment. He sustained his injury during a diving accident in 2012. He was suffering from neurogenic lower urinary tract and Bowel dysfunction. Epidural stimulation of the lumbosacral spinal cord immediately modulated both functions without negatively affecting the cardiovascular system. Specifically, the individual's Bowel function was assessed using different pre-set configurations and stimulation parameters in a randomized order. Compared to the individual's conventional Bowel Management approach, ESCS significantly reduced the time needed for Bowel Management (p = 0.039). Furthermore, depending on electrode configuration and stimulation parameters (i.e., amplitude, frequency, and pulse width), ESCS modulated detrusor pressure and external anal sphincter/pelvic floor muscle tone to various degrees during urodynamic investigation. Although, ESCS is currently being explored primarily for restoring ambulation, our data suggest that application of this neuroprosthetic intervention may provide benefit to lower urinary tract and Bowel function in individuals with SCI. To fully capitalize on the potential of improving lower urinary tract and Bowel function, further research is needed to better understand the neuronal pathways and identify optimal stimulation configurations and parameters.

  • autonomic dysreflexia during Bowel evacuation procedures and bladder filling in subjects with spinal cord injury
    Spinal Cord, 2014
    Co-Authors: P M Faaborg, Soren Laurberg, Andrei V Krassioukov, P Christensen, E Frandsen, Klaus Krogh
    Abstract:

    Randomized, controlled clinical trial. Bladder and Bowel Management may cause serious autonomic dysreflexia (AD) in subjects with high spinal cord injury (SCI). We aimed at investigating autonomic responses to digital rectal evacuation (DE), transanal irrigation (TAI) with 500 ml and filling cystometry (FC) in SCI. Aarhus University Hospital, Denmark. Eight subjects with SCI (AIS A) at or above T6 (high SCI) and a previous history of AD were compared with three subjects with SCI (AIS A) between T10 and L2 (low SCI). In randomized order, DE, TAI and FC were performed. AD was defined as an acute rise in systolic blood pressure (sBP) of ⩾30 mm Hg above baseline. Blood levels of norepinephrine and epinephrine were determined before and shortly after the procedures. During all three procedures, AD occurred in all patients with high SCI but not in those with low SCI. In high SCI subjects, DE increased median sBP from 127 (range: 86–154) to 188 (range: 140–206) mm Hg (P<0.02), TAI from 126 (range: 91–146) to 163 (range: 130–188) mm Hg (P<0.02) and FC from 125 (range: 106–149) to 200 (range: 179–220) mm Hg (P<0.01). The sBP increase was lower during TAI than during DE (P<0.05) or FC (P<0.02). In high SCI subjects, the blood levels of norepinephrine, but not those of epinephrine, increased significantly during all three stimuli (all P<0.05). Bowel and bladder Management caused AD in high SCI. The response is less severe during TAI than during FC or DE.

  • neurogenic Bowel Management after spinal cord injury a systematic review of the evidence
    Spinal Cord, 2010
    Co-Authors: Andrei V Krassioukov, Janice J Eng, G Claxton, Brodie M Sakakibara, S Shum
    Abstract:

    Randomized-controlled trials (RCTs), prospective cohort, case–control, pre–post studies, and case reports that assessed pharmacological and non-pharmacological intervention for the Management of the neurogenic Bowel after spinal cord injury (SCI) were included. To systematically review the evidence for the Management of neurogenic Bowel in individuals with SCI. Literature searches were conducted for relevant articles, as well as practice guidelines, using numerous electronic databases. Manual searches of retrieved articles from 1950 to July 2009 were also conducted to identify literature. Two independent reviewers evaluated each study's quality, using Physiotherapy Evidence Database scale for RCTs and Downs and Black scale for all other studies. The results were tabulated and levels of evidence assigned. A total of 2956 studies were found as a result of the literature search. On review of the titles and abstracts, 57 studies met the inclusion criteria. Multifaceted programs are the first approach to neurogenic Bowel and are supported by lower levels of evidence. Of the non-pharmacological (conservative and non-surgical) interventions, transanal irrigation is a promising treatment to reduce constipation and fecal incontinence. When conservative Management is not effective, pharmacological interventions (for example prokinetic agents) are supported by strong evidence for the treatment of chronic constipation. When conservative and pharmacological treatments are not effective, surgical interventions may be considered and are supported by lower levels of evidence in reducing complications. Often, more than one procedure is necessary to develop an effective Bowel routine. Evidence is low for non-pharmacological approaches and high for pharmacological interventions.

Natasa Milic - One of the best experts on this subject based on the ideXlab platform.

  • the influence of Bowel Management on urodynamic findings in spina bifida children with detrusor overactivity and detrusor sphincter dyssynergia
    Journal of Pediatric Urology, 2020
    Co-Authors: Sasa Milivojevic, Natasa Milic, Jelena Milin Lazovic, Zoran I Radojicic
    Abstract:

    Summary Objective To examine the effects of Bowel Management on urodynamic findings in spina bifida children with detrusor overactivity (DO) and detrusor sphincter dyssynergia (DSD). Material and methods Between 2014 and 2019 we prospectively evaluated 39 consecutive spina bifida children with DO and DSD (18 (46.2%) boys and 21 (53.8%) girls, aged 4–16 years; mean age 9.5 ± 3.7 years) who received Bowel Management and we treated their Bowel dysfunction with an aim of alleviating the symptoms of constipation, preventing constant overdistension of the rectosigmoid, providing regular emptying of the colon and faecal continence. Bowel Management included daily enema, laxative application and a special diet who was performed during 12 months. All children had undergone urodynamic studies before and after starting Bowel Management, with no changes in their urological treatment. Results Bowel Management caused an increase in maximum bladder capacity from 183.0 (112.0–234.0) to 237.0 (165.0–298.0) (p  Conclusion Administering Bowel Management may be useful for bladder function and urodynamic findings in spina bifida children with DO and DSD. Therefore, Bowel Management should form an integral part of the treatment in spina bifida children with DO and DSD. Download : Download high-res image (226KB) Download : Download full-size image

  • the impact of Bowel Management on the quality of life in children with spina bifida with overactive bladder and detrusor sphincter dyssynergia
    Journal of Pediatric Urology, 2019
    Co-Authors: Zoran I Radojicic, Sasa Milivojevic, Natasa Milic, Jelena Milin Lazovic, S Becanovic, I Koricanac
    Abstract:

    Summary Objective The aim of the study was to assess the impact of Bowel Management on the quality of life in children with spina bifida with overactive bladder and detrusor sphincter dyssynergia. Materials and method The research was carried out over the 2014–2017 period, during which 70 patients with spina bifida with overactive bladder and detrusor sphincter dyssynergia were observed. The first group (group 1) consisted of 35 patients who were administered Bowel Management combined with anticholinergic medication therapy and CIC. The second group (group 2) consisted of 35 patients who were treated only with anticholinergic medication therapy and CIC. Bowel Management included daily enema, laxative application, and a special diet, with a view of treating constipation and fecal incontinence that was estimated on the basis of Roma III criteria, the echosonographically determined transversal rectal diameter, and encopresis frequency. The effects of the administered Bowel Management on urinary incontinence were estimated on the basis of the average dry interval between two CICs. Regarding the quality of life, a KINDL questionnaire was used for children and parents to determine the overall quality of life, but also the various aspects of the quality of children's life (physical well-being, emotional well-being, self-confidence, family, friends, school, disease). The test score ranges from 0 to 100, where 0 is the lowest and 100 denotes the highest quality of life. The follow-up period of every patient was one year. Results At baseline, there was no significant difference between the groups regarding demographic and clinical features (p > 0.05). After one year, treatment by Bowel Management demonstrated significant improvement for both fecal constipation/incontinence and urinary incontinence (p  Conclusion Administering Bowel Management considerably alleviates the symptoms of fecal and urinary incontinence and considerably improves the quality of life. Bowel Management should be considered as an integral part of treatment of children with spina bifida. Download : Download high-res image (103KB) Download : Download full-size image Summary Fig.

  • impact of Bowel Management in alleviating symptoms of urinary incontinence in patients with spina bifida associated with overactive bladder and detrusor sphincter dyssynergia
    BJUI, 2019
    Co-Authors: Zoran I Radojicic, Sasa Milivojevic, Natasa Milic, Jelena Milin Lazovic, Marija Lukac, Aleksandar Sretenovic
    Abstract:

    OBJECTIVE To examine the effects of Bowel Management on urinary incontinence in patients with spina bifida associated with overactive bladder (OAB) and detrusor sphincter dyssynergia (DSD). MATERIALS AND METHODS The research was carried out during the period 2014-2017. A total of 35 patients (group 1) were administered Bowel Management combined with anticholinergic medication therapy and clean intermittent catheterization (CIC) and 35 patients (group 2) were treated only with anticholinergic medication therapy and CIC. Bowel Management included daily enema, laxative application and a special diet, with the aim of treating constipation, evaluated according to the Roma III criteria and echosonographically determined transversal rectal diameter. The effects of the administered Bowel Management on urinary incontinence were assessed according to the mean dry interval between two CICs for all patients. All patients were followed up for 1 year, during which data were prospectively collected. RESULTS There was no statistically significant difference with regard to age, gender and baseline clinical features between the two groups. In group 1, the mean ± sd dry interval between two CICs was 150.0 ± 36.4 min, and group 2 it was 101.3 ± 51.6 min. There was a significant difference in urinary incontinence, i.e. in the mean dry interval, between the two groups (P < 0.001). CONCLUSION Administering Bowel Management considerably increased the mean dry interval, thus greatly alleviating the symptoms of urinary incontinence. For this reason, Bowel Management should form an integral part of the treatment of patients with spina bifida and OAB and DSD.

  • the influence of Bowel Management on the frequency of urinary infections in spina bifida patients
    Journal of Pediatric Urology, 2018
    Co-Authors: Zoran I Radojicic, Sasa Milivojevic, Natasa Milic, Jelena Milin Lazovic, Marija Lukac, Aleksandar Sretenovic
    Abstract:

    Summary Objective To examine the effects of Bowel Management on the frequency of urinary infections in spina bifida patients. Study design The research was carried out from 2014 to 2017, with the recruitment process from June 2014 to March 2016. The first group consisted of 35 patients who were administered Bowel Management combined with anticholinergic medication therapy and clean intermittent catheterization (CIC). The second group consisted of 35 patients who were treated only with anticholinergic medication therapy and CIC. Bowel Management included daily enema, laxative application, and a special diet, with a view to treating constipation that was estimated on the basis of Roma III criteria and echosonographically determined transversal rectal diameter. The effects of the administered Bowel Management on urinary infections were estimated on the basis of the number of urinary infections before and after the administered therapy. The observation period of every patient was 1 year. Results There were no significant statistical differences regarding age, gender, and baseline clinical features between the two groups. In the group treated with Bowel Management combined with anticholinergic medication therapy and CIC, the average number of urinary infections was 0.3 ± 0.5 SD, whereas in the group treated exclusively with anticholinergic medication therapy and CIC the average number of urinary infections was 1.1 ± 1.0 SD. There was a statistical difference regarding urinary infections, that is the average number of urinary infections between these two groups of patients (p  Conclusion Administering Bowel Management considerably decreases the frequency of urinary infections, and should form an integral part of treatment of spina bifida patients. Download : Download high-res image (159KB) Download : Download full-size image Figure . Average number of urinary infections in groups with and without Bowel Management.

Alberto Peña - One of the best experts on this subject based on the ideXlab platform.

  • damaged anal canal as a cause of fecal incontinence after surgical repair for hirschsprung disease a preventable and under reported complication
    Journal of Pediatric Surgery, 2017
    Co-Authors: Andrea Bischoff, Marc A Levitt, Belinda H Dickie, Lyndsey Jackson, Monica Holder, Jason S Frischer, Jennifer Leslie Knod, Alberto Peña
    Abstract:

    Abstract Introduction Fecal incontinence after the surgical repair of Hirschsprung disease is a potentially preventable complication that carries a negative impact on patient's quality of life. Methods Patients that were previously operated for Hirschsprung disease and presented to our Bowel Management clinic with the complaint of fecal incontinence were retrospectively reviewed. All patients underwent a rectal examination under anesthesia looking for anatomic explanations for their incontinence. Results One hundred three patients were identified. 54 patients had a damaged anal canal. 22 patients also had a patulous anus. The operative reports mentioned the pectinate line in 32 patients, in 12 it was not mentioned, and in 10 patients the operative report was not available. All patients with a damaged anal canal suffered from true fecal incontinence; 45 of them are on daily enemas (41 are clean and 4 are still having “accidents”), 7 are not doing Bowel Management due to noncompliance and 2 patients have a permanent ileostomy. 49 patients did not have a damaged anal canal, 25 of those responded to changes in diet and medication and are having voluntary Bowel movements. Conclusion Fecal incontinence may occur after an operation for Hirschsprung disease. When the anal canal is damaged, incontinence is always present, severe, and probably permanent. The preservation of the anal canal may avoid this complication.

  • evaluation and treatment of the patient with hirschsprung disease who is not doing well after a pull through procedure
    Seminars in Pediatric Surgery, 2010
    Co-Authors: Marc A Levitt, Belinda H Dickie, Alberto Peña
    Abstract:

    Ideally, after operative Management of Hirschsprung disease, a child should thrive, avoid recurrent episodes of abdominal distention and enterocolitis, and be fecally continent. However, there is a small group of patients that do not do well after their pull-through procedure. The purpose of this article is to describe our algorithm for the work-up and Management of the post pull-through patient with Hirschsprung disease who is not doing well. These children can be categorized into 2 distinct groups: (1) those who are soiling, and (2) those who suffer from distention and enterocolitis. Both of these patient types can be systematically treated with a combination of Bowel Management, dietary changes, and laxatives, and, potentially, a redo operation, with the goal of having a clean, and happy child.

  • Bowel Management for the treatment of pediatric fecal incontinence
    Pediatric Surgery International, 2009
    Co-Authors: Andrea Bischoff, Marc A Levitt, Alberto Peña
    Abstract:

    Fecal incontinence is a devastating underestimated problem, affecting a large number of individuals all over the world. Most of the available literature relates to the Management of adults. The treatments proposed are not uniformly successful and have little application in the pediatric population. This paper presents the experience of 30 years, implementing a Bowel Management program, for the treatment of fecal incontinence in over 700 pediatric patients, with a success rate of 95%. The main characteristics of the program include the identification of the characteristics of the colon of each patient; finding the specific type of enema that will clean that colon and the radiological monitoring of the process.

  • treatment of fecal incontinence with a comprehensive Bowel Management program
    Journal of Pediatric Surgery, 2009
    Co-Authors: Andrea Bischoff, Marc A Levitt, Cathy L Bauer, Lyndsey Jackson, Monica Holder, Alberto Peña
    Abstract:

    Abstract Purpose Many articles describe the antegrade continence enemas (ACEs), but few refer to a Bowel Management program. A successful ACE may not help a patient without such Management. Valuable lessons were learned by implementation of Bowel Management in 495 fecally incontinent patients. Methods We previously reported 201 patients. Thereafter, another 294 patients participated in our program. On the basis of a contrast enema and symptoms, they were divided as follows: ( a ) 220 constipated patients and ( b ) 74 patients with tendency toward diarrhea. Colonic stool was monitored with abdominal radiographs, modifying the Management according to the patient's response and radiologic findings. For constipated patients, the emphasis was on using large enemas. For patients with tendency toward diarrhea, we used small enemas, a constipating diet, loperamide, and pectin. Diagnoses included anorectal malformation (223), Hirschsprung's (36), spina bifida (12), and miscellaneous (23). Results The Management was successful in 279 patients (95%)—higher in constipated patients (98%) and less successful in patients with tendency toward diarrhea (84%). Conclusions The key to a successful Bowel Management program rests in tailoring the type of enema, medication, and diet to the specific type of colon. The best way to determine the effect of an enema is with an abdominal film. The ACE procedures should be recommended only after successful Bowel Management.

  • reoperations in hirschsprung disease
    Journal of Pediatric Surgery, 2007
    Co-Authors: Alberto Peña, Mehmet Elicevik, Marc A Levitt
    Abstract:

    Abstract Background We sought to identify causes of preventable complications related to operations for Hirschsprung disease. Methods We reviewed the cases of 51 patients with Hirschsprung disease who underwent a primary procedure elsewhere, had a complication, and were referred for reoperation. Results Thirty-five patients had 1 failed operation, 10 had 2, and 6 had 3. Initial operations were Soave (20), Duhamel (15), Swenson (5), transanal endorectal (4), myectomy (3), unknown (3), and laparoscopic Swenson (1). Thirty-one patients presented with a stoma. Patients without a stoma (20) had fecal impaction (8), recurrent enterocolitis (6), and fecal incontinence (6). None had both enterocolitis and incontinence. Reoperation was performed posterior sagittally (40) or transanally (5). Indications included stricture (21), megarectal Duhamel pouches (12), fistulae (11 [8 rectocutaneous, 2 rectourethral, and 1 rectovaginal]), pouchitis (2), and retained aganglionic Bowel (8). After reoperation, 14 were continent, 11 had a stoma (8 permanent), 6 had voluntary Bowel movements but soiled occasionally, 6 received rectal irrigations to avoid enterocolitis, 6 were incontinent but clean with Bowel Management, and 2 were lost to follow-up. Conclusion Stricture, megarectal pouch, fistula, and retained aganglionic Bowel are preventable complications. Enterocolitis is partially preventable but can occur after a technically correct procedure. Fecal incontinence is a preventable complication likely because of anal canal damage.