title: Peristeen(®) transanal irrigation in paediatric patients with anorectal malformations and spinal cord lesions: a multicentre Italian study.
abstract: OBJECTIVE
  In paediatric and adult patients with neurogenic bowel, transanal irrigation (TAI) of the colon has gained popularity due to the introduction of a specifically designed device. The aim of this pilot study was to present the results of TAI using the Peristeen(®) TAI system in a group of paediatric patients with anorectal malformation (ARM) and congenital or acquired spinal cord lesions (SCLs).
  
  
  METHODS
  Eight Italian paediatric surgery and spina bifida centres participated in the study. The inclusion criteria were age between 6 and 17 years, weight above 20 kg and unsatisfactory bowel management. Patients with chronic inflammatory bowel disease, mental disability and surgery within the previous 3 months were excluded. At the beginning of treatment (T0) and after 3 months (T1) the Bristol scale, a questionnaire assessing bowel function, and two questionnaires on quality of life (QoL) for patients aged 6-11 years (CHQ-pf50) and 12-17 years (SF36) were administered.
  
  
  RESULTS
  Eighty-three patients were enrolled, and seventy-eight completed the study (41 ARMs, 37 SCLs). At T1, constipation was reduced in ARMs from 69% to 25.6% and in SCLs from 92.7% to 41.5%, faecal incontinence in ARMs from 50% to 18.6% and in SCLs from 39% to 9.8% and flatus incontinence in ARMs from 20.9% to 9.8% and in SCLs from 31.7% to 10%. At T0, the Bristol Stool Scale types were 1-2 in 45% of ARMs and 77.5% of SCL patients, whereas at T1 types 1-2 were recorded in only 2.5% of SCL patients. QoL improved in both groups. In the younger group, a significant improvement in QoL was recorded in ARM patients for eight of nine variables and in SCL patients for seven of nine variables.
  
  
  CONCLUSIONS
  This study showed that Peristeen TAI resulted in a significant time reduction in colonic cleansing, increased independence from the carer and improved QoL in paediatric patients with ARMs and SCLs.
authors: Pediatric Surgery Unit, Department of Woman and Child Health, University Hospital, Padua, Italy.
authors: P
authors: P
authors: Midrio
authors: Neuro-Urology Unit/Spina Bifida Center and Department of Medical and Surgical Neonatology, Bambino Gesù Children Hospital and Research Institute, Rome, Italy.
authors: G
authors: http://orcid.org/0000-0003-2282-8207
authors: G
authors: Mosiello
authors: Spina Bifida Center, Department of Paediatric Science, Catholic University Medical School, Rome, Italy.
authors: E
authors: E
authors: Ausili
authors: Pediatric Surgery Unit, Department of Woman and Child Health, University Hospital, Padua, Italy.
authors: P
authors: P
authors: Gamba
authors: Pediatric Surgery Unit, Second University of Naples, Naples, Italy.
authors: A
authors: A
authors: Marte
authors: Pediatric Surgery Unit, Pediatric Hospital, Parma, Italy.
authors: L
authors: L
authors: Lombardi
authors: Neuro-Urology Unit/Spina Bifida Center and Department of Medical and Surgical Neonatology, Bambino Gesù Children Hospital and Research Institute, Rome, Italy.
authors: B D
authors: BD
authors: Iacobelli
authors: Pediatric Surgery Unit, Vittore Buzzi Pediatric Hospital, Milan, Italy.
authors: E
authors: E
authors: Caponcelli
authors: Pediatric Surgery Unit, Annunziata Hospital, Cosenza, Italy.
authors: S
authors: S
authors: Marrello
authors: Pediatric Surgery Unit, Vittore Buzzi Pediatric Hospital, Milan, Italy.
authors: M
authors: M
authors: Meroni
authors: Department of Pediatric Surgery, Fondazione Ca'Granda - Ospedale Maggiore Policlinico, Milan, Italy.
authors: G
authors: G
authors: Brisighelli
authors: Department of Pediatric Surgery, Fondazione Ca'Granda - Ospedale Maggiore Policlinico, Milan, Italy.
authors: E
authors: E
authors: Leva
authors: Spina Bifida Center, Department of Paediatric Science, Catholic University Medical School, Rome, Italy.
authors: C
authors: C
authors: Rendeli
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000002:abnormalities; D000071056:Anorectal Malformations; D001006:Anus, Imperforate; D002648:Child; D003248:Constipation / Q000209:etiology / Q000628:therapy*; D004733:Enema / Q000295:instrumentation*; D005242:Fecal Incontinence / Q000209:etiology / Q000628:therapy*; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology / Q000628:therapy; D006801:Humans; D007558:Italy; D008297:Male; D010865:Pilot Projects; D012007:Rectum / Q000002:abnormalities; D013119:Spinal Cord Injuries / Q000150:complications; D016135:Spinal Dysraphism / Q000150:complications; D007507:Therapeutic Irrigation / Q000295:instrumentation*
keywords: Anorectal malformation; Peristeen; bowel dysfunction; enema; spinal cord injuries; transanal irrigation