title: Improvement of continence with reoperation in selected patients after surgery for anorectal malformation.
abstract: OBJECTIVE
  Fecal incontinence is a serious complication after repair of anorectal malformations. We investigated whether reoperation can improve fecal continence.
  
  
  METHODS
  Medical records of 41 patients (40 children and one adult; 26 male and 15 female) who underwent reoperation after previous reconstruction of an anorectal malformation were reviewed for outcomes of bowel function. Type of primary corrective surgery performed, therapeutic measures, results of physical examination and barium enema, and reoperation procedures were evaluated. A questionnaire was administered to assess stool behaviour and level of continence at follow-up three or more years after secondary operation.
  
  
  RESULTS
  Secondary operations in males comprised posterior sagittal anorectoplasty (PSARP) in 16 patients, PSARP with antegrade continent enema in one patient, antegrade continent enema alone in 6, anoplasty in one, rectosigmoid resection in 1, and definitive colostomy in 1 patient. Secondary operations in females included PSARP alone in 4 patients, PSARP with total urogenital mobilization in 4, PSARP with vaginoplasty in 2, PSARP with vaginoplasty and antegrade continent enema in 2, and PSARP with vaginourethroplasty in 3. Of 41 patients 18 (44 percent) were continent at follow-up, 21 (51 percent) were clean with use of enemas, diet, or drug therapy. One patient had a definitive colostomy. One died after kidney transplantation.
  
  
  CONCLUSIONS
  Surgery is a good option for improving incontinence in selected patients previously operated for anorectal malformations. Posterior sagittal anorectoplasty is advocated to improve bowel control. Antegrade continent enema is a reliable therapeutic option to maintain clean patients with fecal incontinence.
authors.affiliation: Department of Pediatric Surgery, Paracelsus Medical University, Salzburg, Austria. m.ardelean@salk.at
authors.forename: Mircia-Aurel
authors.initials: MA
authors.lastname: Ardelean
authors.forename: Jan
authors.initials: J
authors.lastname: Bauer
authors.forename: Christa
authors.initials: C
authors.lastname: Schimke
authors.forename: Barbara
authors.initials: B
authors.lastname: Ludwikowski
authors.forename: Günther
authors.initials: G
authors.lastname: Schimpl
mesh_terms: D001003:Anal Canal / Q000002:abnormalities* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications; D012007:Rectum / Q000002:abnormalities* / Q000601:surgery; D012086:Reoperation; D014551:Urinary Tract / Q000002:abnormalities / Q000601:surgery