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The treatment of imperforate anus: experience with 108 patients
1National Chen-Kung University Hospital, Tainan, Taiwan.
Insights
This study on imperforate anus treatment in infants shows the posterior sagittal anorectoplasty leads to good bowel control. While constipation is common in high-type lesions, most infants achieve voluntary bowel movements.
Area of Science:
- Pediatric Surgery
- Congenital Anomalies
- Anorectal Malformations
Background:
- Imperforate anus is a congenital condition requiring surgical correction.
- Treatment outcomes can vary, with Western series reporting specific challenges.
Purpose of the Study:
- To present surgical experience and outcomes for imperforate anus in infants over a decade.
- To compare findings with existing Western literature.
Main Methods:
- A cohort of 108 infants with imperforate anus were treated between 1988 and 1998.
- Low lesions were managed with posterior sagittal anorectoplasty; high lesions required a three-stage approach (colostomy, PSARP, takedown).
- Postoperative function assessed by voluntary bowel movement, soiling, and constipation over 6 months to 10 years.
Main Results:
- Two patient deaths occurred (congenital anomalies, hyaline membrane disease).
- 98% of patients achieved voluntary bowel movements; 3% experienced soiling, and 17% had constipation (improving over time).
- Redo posterior sagittal anorectoplasty improved soiling in previously operated patients.
Conclusions:
- The posterior sagittal anorectoplasty technique yields high rates of continence and voluntary bowel movements.
- Constipation is a notable issue in high-type lesions but often manageable.
- Lower incidence of sacral/urogenital anomalies may contribute to superior outcomes compared to Western series.
Background/Purpose:
The authors present their experience and results in the treatment of infants with imperforate anus over a 10-year period. Differences between these and previously published western results are noted and discussed.
Methods:
One hundred eight patients with imperforate anus were treated from June 1988 to July 1998. Of these patients, 66 were boys and 42 were girls. Associated anomalies include congenital heart disease, anomalies of bone and cartilage, and Down's syndrome. Thirty-five patients with a low lesion received a limited posterior sagittal anorectoplasty. Seventy-one patients had a high lesion and received 3-staged operations including colostomy, posterior sagittal anorectoplasty, and takedown of colostomy. All patients underwent follow-up by the author. Postoperative anorectal function was evaluated based on the following criteria: ability to have voluntary bowel movement, soiling, and constipation. The duration of follow-up ranges from 6 months to 10 years.
Results:
One patient died of multiple congenital anomalies after colostomy. One patient died of hyaline membranous disease. All except 2 patients had voluntary bowel movement. Three patients had soiling, and 19 suffered from constipation after operation. The constipation improved with medical treatment and time. Four patients who received the first operation at another hospital (3 underwent posterior sagittal anorectoplasty and 1 had cutback anoplasty) had problems with soiling. In these patients, soiling improved after redo posterior sagittal anorectoplasty.
Conclusions:
Utilizing the posterior sagittal operation described by Peña, most patients were continent and able to have voluntary bowel movements. Constipation occurred in a substantial number of patients with high-type lesions, but few of these patients needed medication or enemas. There were significantly fewer sacral and urogenital anomalies than have been reported in most western series. This may explain the excellent results.