Is normal bowel function possible after repair of intermediate and high anorectal malformations?
The bowel function of 46 patients who had undergone internal sphincter-saving posterior sagittal anorectoplasty (PSARP) was evaluated by a questionnaire 3 to 10 years after the closure of the colostomy. The bowel function was assessed by a multivariate scoring method. All patients had also been followed up clinically and manometrically. Seventy healthy children with a similar age and sex distribution were used as controls. Sixteen (35%) patients had bowel function scores that were within the range of the scores of healthy children (mean score of healthy children +/- SD). Another 16 (35%) patients with intermediate scores had a clinically good continence. Fourteen (30%) patients with low scores had a clinically fair or poor functional result; 3 of them required enemas because of severe constipation and 11 used protective aids or had to change underwear frequently because of daily soiling. There was a correlation between a good continence outcome and the presence of a functional internal sphincter and high anorectal resting pressure. Absence of a functional internal sphincter, severe sacral anomalies, and constipation were associated with poor functional results. It is concluded that normal bowel function after internal sphincter-saving PSARP may be expected in a significant proportion of children with high or intermediate anorectal anomalies.
Rintala
R J
RJ
Children's Hospital, University of Helsinki, Finland.
Lindahl
H
H
D001003:Anal Canal / Q000002:abnormalities*; D016022:Case-Control Studies; D002648:Child; D000013:Congenital Abnormalities / Q000601:surgery; D003248:Constipation / Q000453:epidemiology*; D005242:Fecal Incontinence / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008365:Manometry; D011183:Postoperative Complications / Q000453:epidemiology* / Q000517:prevention & control; D012007:Rectum / Q000002:abnormalities*; D011795:Surveys and Questionnaires; D013997:Time Factors; D014549:Urinary Incontinence / Q000453:epidemiology