Anterior resection for megarectosigmoid in congenital anorectal malformations.
OBJECTIVE
The aim of this study was to review the effectiveness of resecting dilated distal bowel in children suffering unmanageable constipation or soiling who have been operated on previously for anorectal malformations.


METHODS
A retrospective review was performed of 9 children. Each child underwent excision of dilated bowel to leave normal caliber bowel anastomosed by hand to a rectal reservoir at the peritoneal reflection. The documented follow-up was reviewed.


RESULTS
The 9 children had primary surgery for the following anomalies: high (n = 1), intermediate (n = 1), low (n = 3), rectal stenosis (n = 3), and anal stenosis (n = 3), Seven children had persistent fecalomas, and 7 had major problems with soiling. All were on large doses of laxatives, with 5 having regular rectal washouts and 4 having regular enemas. In all radiologic studies there was a prompt change from normal caliber bowel to dilated bowel at the upper limit of the dilatation. The mean age at operation for excision was 4 years, 11 months (range, 11 months to 9 years, 11 months). The mean period of follow-up was 4 years, 7 months (range, 2 years, 3 months to 10 years). Follow-up showed that all children improved. None had major complications. All were having between one and 3 bowel actions per day. Three continued to soil but improved. Of the remaining 6, only 2 required occasional laxatives and had regular spontaneous bowel actions without soiling. No child was having enemas or washouts.


CONCLUSIONS
Anterior resection for the treatment of megarectosigmoid is a safe and effective procedure.
Hallows
M R
MR
Department of Paediatric Surgery, The Birmingham Children's Hospital NHS Trust, and The University of Birmingham, Birmingham, England.
Lander
A D
AD
Corkery
J J
JJ
D001003:Anal Canal / Q000002:abnormalities*; D000714:Anastomosis, Surgical / Q000379:methods; D002648:Child; D002675:Child, Preschool; D012809:Colon, Sigmoid / Q000473:pathology*; D003248:Constipation / Q000209:etiology; D013505:Digestive System Surgical Procedures / Q000379:methods*; D004108:Dilatation, Pathologic; D005242:Fecal Incontinence / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D012007:Rectum / Q000002:abnormalities* / Q000473:pathology*; D012189:Retrospective Studies