Assessing the benefit of reoperations in patients who suffer from fecal incontinence after repair of their anorectal malformation.
Document Type
Article
Publication Date
10-2020
Identifier
DOI: 10.1016/j.jpedsurg.2020.06.011
Abstract
Background and aim: Patients with a previously repaired anorectal malformation (ARM) can suffer from complications which lead to incontinence. Reoperation can improve the anatomic result, but its impact on functional outcomes is unclear.
Methods: We performed a retrospective cohort study of patients with a previously repaired ARM who underwent redo PSARP at our Center and compared results at initial assessment and 12 months after redo.
Results: One hundred fifty-three patients underwent a redo PSARP for anoplasty mislocation (n=93, 61%), stricture (n=55, 36%), remnant of the original fistula (n=28, 18%), or rectal prolapse (n=11, 7%). Post-redo complications included stricture (n=33, 22%) and dehiscence (n=5, 3%). At 1-year post-redo, 75/153 (49%) are on laxatives only, of whom 57 (76%) are continent of stool. Of the remaining 78 (51%) patients, 61 (78%) are clean ( ≤ 1 accident per week) on enemas. Interestingly, 16/79 (20%) of patients with expected poor continence potential were continent of stool on laxatives. Overall, 118/153 (77%) are clean after their redo. Quality of life (76.7 vs. 83.8, p=0.05) and Baylor continence (29.2 vs. 17.7, p= < 0.0001) scores improved.
Conclusion: Patients with fecal incontinence after an ARM repair can, with a reoperation, have their anatomy corrected which can restore continence for many, and improve their quality of life.
Level of evidence: IV.
Type of study: Retrospective cohort study.
Journal Title
Journal of pediatric surgery
Volume
55
Issue
10
First Page
2159
Last Page
2165
MeSH Keywords
Anal Canal; Anorectal Malformations; Child, Preschool; Constriction, Pathologic; Fecal Incontinence; Female; Fistula; Humans; Laxatives; Male; Quality of Life; Reconstructive Surgical Procedures; Rectal Prolapse; Rectum; Reoperation; Retrospective Studies; Surgical Wound Dehiscence; Treatment Outcome
Keywords
Anorectal malformation; Fecal continence; Imperforate anus; Incontinence; PSARP; Redo posterior sagittal anorectoplasty
Recommended Citation
Wood RJ, Halleran DR, Ahmad H, et al. Assessing the benefit of reoperations in patients who suffer from fecal incontinence after repair of their anorectal malformation. J Pediatr Surg. 2020;55(10):2159-2165. doi:10.1016/j.jpedsurg.2020.06.011
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