{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T06:37:07Z","timestamp":1780468627088,"version":"3.54.1"},"reference-count":36,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2021,12,11]],"date-time":"2021-12-11T00:00:00Z","timestamp":1639180800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>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\u2019s disease, 24 neurological impairment, 20 functional incontinence) submitted to a comprehensive protocol with Peristeen\u00ae: 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.<\/jats:p>","DOI":"10.3390\/children8121174","type":"journal-article","created":{"date-parts":[[2021,12,13]],"date-time":"2021-12-13T01:28:11Z","timestamp":1639358891000},"page":"1174","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Advanced Management Protocol of Transanal Irrigation in Order to Improve the Outcome of Pediatric Patients with Fecal Incontinence"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3196-705X","authenticated-orcid":false,"given":"Anna Maria","family":"Caruso","sequence":"first","affiliation":[{"name":"Pediatric Surgical Unit, Children\u2019s Hospital \u2018G. di Cristina\u2019, ARNAS Civico-Di Cristina Benfratelli, 90100 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario Pietro Marcello","family":"Milazzo","sequence":"additional","affiliation":[{"name":"Pediatric Surgical Unit, Children\u2019s Hospital \u2018G. di Cristina\u2019, ARNAS Civico-Di Cristina Benfratelli, 90100 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denisia","family":"Bommarito","sequence":"additional","affiliation":[{"name":"Pediatric Surgical Unit, Children\u2019s Hospital \u2018G. di Cristina\u2019, ARNAS Civico-Di Cristina Benfratelli, 90100 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincenza","family":"Girgenti","sequence":"additional","affiliation":[{"name":"Pediatric Surgical Unit, Children\u2019s Hospital \u2018G. di Cristina\u2019, ARNAS Civico-Di Cristina Benfratelli, 90100 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Glenda","family":"Amato","sequence":"additional","affiliation":[{"name":"Pediatric Surgical Unit, Children\u2019s Hospital \u2018G. di Cristina\u2019, ARNAS Civico-Di Cristina Benfratelli, 90100 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Paviglianiti","sequence":"additional","affiliation":[{"name":"Pediatric Radiology Unit, Children\u2019s Hospital \u2018G. di Cristina\u2019, ARNAS Civico-Di Cristina Benfratelli, 90100 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5676-9535","authenticated-orcid":false,"given":"Alessandra","family":"Casuccio","sequence":"additional","affiliation":[{"name":"Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieralba","family":"Catalano","sequence":"additional","affiliation":[{"name":"Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcello","family":"Cimador","sequence":"additional","affiliation":[{"name":"Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Rita","family":"Di Pace","sequence":"additional","affiliation":[{"name":"Pediatric Surgical Unit, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities, University of Palermo, 90127 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,12,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1111\/apt.12103","article-title":"Review article: Faecal incontinence in children: Epidemiology, pathophysiology, clinical evaluation and management","volume":"37","author":"Rajindrajith","year":"2013","journal-title":"Aliment. 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