title: Surgical approach for fecal incontinence with a patulous anus after transanal pull-through for Hirschsprung disease.
abstract: BACKGROUND
  We have performed transanal pull-through (TAPT) for Hirschsprung disease since 1998. Some of our patients after TAPT showed a patulous anus and suffered from severe true fecal incontinence. We performed anal canal plasty for these patients and evaluated its efficacy in restoring anorectal function.
  
  
  METHODS
  Thirty-one patients who were ≥5years old were previously operated on for Hirschsprung disease, and seven (22.5%) of these were indicated for this procedure. Anorectal function was evaluated using the Japanese Study Group of Anorectal Anomalies (JSGA) clinical assessment of defecation function score. For surgery, the patients were positioned in the prone jackknife posture. The posterior half of the anal canal was exposed and folded inward until the anal canal lumen was as narrow as the surgeon's index finger. External anal sphincter muscles were repaired, and the wound was closed vertically.
  
  
  RESULTS
  The mean preoperative JSGA score was 1.42±0.4. The mean JSGA scores at 2-6months and 2years after this procedure were 5±2.1 and 5.8±2.1, respectively. Postoperatively, the JSGA score significantly improved at both times (p<0.05).
  
  
  CONCLUSIONS
  Anal canal plasty may be effective for true fecal incontinence and a patulous anus after TAPT. This surgical approach may be useful for these conditions.
  
  
  METHODS
  Type of study: Treatment study, Level IV.
authors.affiliation: Department of Pediatric Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa 920-0293, Japan. Electronic address: yoshitom@kanazawa-med.ac.jp.
authors.forename: Yoshitomo
authors.initials: Y
authors.lastname: Yasui
authors.affiliation: Department of Pediatric Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa 920-0293, Japan.
authors.forename: Syoichi
authors.initials: S
authors.lastname: Nishida
authors.affiliation: Department of Pediatric Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa 920-0293, Japan.
authors.forename: Tsubasa
authors.initials: T
authors.lastname: Shironomae
authors.affiliation: Department of Pediatric Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa 920-0293, Japan.
authors.forename: Miwa
authors.initials: M
authors.lastname: Satomi
authors.affiliation: Department of Pediatric Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa 920-0293, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Kuwahara
authors.affiliation: Department of Pediatric Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa 920-0293, Japan.
authors.forename: Miyuki
authors.initials: M
authors.lastname: Kohno
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000601:surgery*; D002648:Child; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006627:Hirschsprung Disease / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000601:surgery*; D016896:Treatment Outcome
keywords: Anal canal plasty; Fecal incontinence; Hirschsprung disease; Transanal endorectal pull-through operation