Pectinatoplasty: a technique for treatment of sensory fecal incontinence.
Nineteen patients (12 boys, 7 girls; mean age, 6.2 +/- 1.6 SD years) had fecal incontinence owing to absence of the ectodermal lining of the lower rectal neck. Physical examination findings were normal. The anal mucosa extended to the anal verge and was insensitive; there was no ectodermal lining or pectinate line in the lower rectal neck. The 19 patients were selected from a group of 62 patients with anorectal agenesis who had undergone an abdominoanal pull-through operation. The criterion for inclusion in the study was normal anorectal physiology. "Pectinatoplasty" was carried out with the patient under local anesthesia. Two 1.5- x 1.5-cm cutaneous flaps from each of the 5 and 12 o'clock positions of the perianal skin were advanced into the lower rectal neck at the site of an excised mucosal patch of similar size. The patients were discharged on the day of operation. Sixteen patients became continent. Two patients did not improve because of dislocation of the cutaneous flaps outside the anal orifice, as a result of suturing under tension; they became continent after regrafting, using two lateral flaps placed at the 3 and 9 o'clock positions. One patient had anal stenosis and was subjected to dilatation. Pectinatoplasty proved successful in restoring fecal continence in patients who lacked ectodermal anal lining. The procedure is simple, easy, and can be performed on an outpatient basis.
Shafik
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Department of Surgery and Experimental Research, Faculty of Medicine, Cairo University, Egypt.
D002648:Child; D002675:Child, Preschool; D005242:Fecal Incontinence / Q000601:surgery*; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000637:transplantation*; D008297:Male; D018579:Patient Selection; D012007:Rectum / Q000002:abnormalities / Q000294:innervation* / Q000601:surgery; D012678:Sensation Disorders / Q000503:physiopathology / Q000601:surgery*; D013524:Surgical Flaps / Q000379:methods*; D014945:Wound Healing