Clinical profile, management and post operative outcome in patients with anorectal malformations
DOI:
https://doi.org/10.18203/2349-3291.ijcp20231840Keywords:
ARM, PSARP, Kelly’s score, Fecal incontinenceAbstract
Background: Anorectal malformations (ARM) form a very important group of anomalies dealt by pediatric surgeons. Identification of different forms of the anomaly, planning investigation and definitive surgical procedure to attain the final goal of a continent child, remains a difficult task till date. Aim of the study was to study complete clinical profile of the ARM patient, surgical procedure and post operative outcome with special emphasis on continence.
Methods: We conducted a study at Geetanjali medical college, Udaipur, Rajasthan, India for clinical profile and management of patients with ARM with assessment of post-operative outcome. All cases of ARM operated from August 2016 to June 2021 were included in the study. All aspects of the anomaly i.e., type, age and sex distribution, associated anomalies, surgical technique used and post op complications were assessed. Evaluation of continence was done by Kelly's scoring system.
Results: The 71% patients had staged surgery with posterior sagittal ano-rectoplasty (PSARP) being the most common procedure used (71%). Immediate post op complications were nil. Incontinence was present in 29% patients. Constipation was present in 46% patients. On assessing Kelly's scoring 96% patients had satisfactory score. Postoperative continence was achieved in 70.8% and in 83.3% patients after treatment (bowel management).
Conclusions: Meticulous planning and surgical technique with sphincter identification and proper placement of ano-rectum are most important to achieve desired results. Kelly's scoring is important to assess post operative results and plan management for incontinence. With aggressive bowel management it is possible to achieve reasonable continence and quality of life for even those anomalies with poor prognosis.
Metrics
References
Bhatnagar V. Assessment of postoperative results in anorectal malformations. J Indian Assoc Pediatr Surg. 2005;10:80-5.
Cremin BJ, Cywes S, Louw JH. A rational radiological approach to the surgical correction of anorectal anomalies. Surgery. 1972;71:801-6.
Peña A, Devries PA. Posterior sagittal anorectoplasty: Important technical considerations and new applications. J Pediatr Surg. 1982;17(6):796-811.
Dubois A. Recueil Periodique de la Societe de Medecine de Paris. 1783;3:125.
O’Neill JA, Rowe MI, Jay L, Grosfeld EW. Fonkalsrud, Arnold G. Coran. Pediatric Surgery. 5th edition: Mosby. 1998.
Nakayama DK, Templeton JM Jr, Ziegler MM, O'Neill JA, Walker AB. Complications of posterior sagittal anorectoplasty. J Pediatr Surg. 1986;21(6):488-92.
Chatterjee SK. Rare/regional variants. In: Holschneider AM, Hutson JM, editors. Anorectal Malformations in Children Embryology, Diagnosis, Surgical Treatment, Follow-Up. Berlin, Heidelberg: Springer. 2006;251-62.
Stephens FD, Smith ED. Ano Rectal Malformations in children, YearBook Medicals, Chicago. 1971.
Mittal A, Airon RK, Magu S, Rattan KN, Ratan SK. Associated anomalies with anorectal malformation (ARM). Indian J Pediatric. 2004;71(6):509-14.
Boocock GR, Donnai D. Anorectal malformations: familial aspects and associated anomalies. Arch Dis Child. 1987;62:576-9.
Watanabe Y, Ando H, Seo T, Kaneko K, Katsuno S, Shinohara T et al. Three-dimensional image reconstruction of an anorectal malformation with multidetector-row helical computed tomography technology. Pediatric Surgery Int. 2003;19:167-71.
Gangopadhyay AN, Pandey V. Anorectal malformations. J Indian Assoc Pediatric Surg. 2015;20(1):10-5.
Gangopadhyay AN, Gopal SC, Sharma S, Gupta DK, Sharma SP, Mohan TV. Management of anorectal malformations in Varanasi, India: a long-term review of single and three stage procedures. Pediatr Surg Int. 2006;22(2):169-72.
Hedlund H. Longterm anorectal function in imperforateanus treated by a posterior sagittal anorectoplasty: manometricinvestigation. Pediatr Surg. 1992;27:906.
Rintala R. Constipation is a major functional complication after internal sphincter-saving posterior sagittal anorectoplasty for high and intermediate anorectal malformations. J Pediatr Surg. 1993;28:1054.
Schmiedeke E, Busch M, Stamatopoulos E, Lorenz C. Multidisciplinary behavioural treatment of fecal incontinence and constipation after correction of anorectal malformation. World J Pediatric. 2008;4(3):206-10.
Tsuji H, Okada A, Nakai H, Azuma T, Yagi M, Kubota A. Follow-up studies of anorectal malformations after posterior sagittal anorectoplasty. J Pediatr Surg. 2002;37(11):1529-33
Bliss DP, Tapper D, Sanderson JM, Schaller RT, Hatch EJ, Morgan A et al. Does posterior sagittal anorectoplasty in patients with high imperforate anus provide superior fecal continence? J Pediatr Surg. 1996;31:26-32.
Iwai N, Fumino S. Surgical treatment of anorectal malformations. Surgery Today. 2013;43(9):955-62.
Pena A. Anorectal malformations. Semin Pediatr Surg. 1995;4:35-47.
Goon HK. Repair of anorectal anomalies in the neonatal period. Pediatric Surgery Int. 1990;5;246-9.
Squire R. The clinical application of the malone antegradecolonic enema. J Pediatrics Surg. 1993;28:1012.
Downloads
Published
How to Cite
Issue
Section
