Related Experiment Videos
Incontinence and constipation after low anorectal malformations in a boy
S Labouré1, R Besson, M D Lamblin
1Department of Paediatric Surgery, Jeanne de Flandres Hospital, University of Lille, France.
Insights
Low anorectal malformations can lead to long-term continence issues in children. Regular clinical follow-up and anorectal manometry are recommended for early detection and management of these problems.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Urology
Background:
- Low anorectal malformations (LAM) are typically considered benign congenital anomalies.
- Neonatal surgical treatment of LAM generally yields good functional outcomes regarding continence.
Observation:
- A cohort of 55 boys with LAM treated between 1975-1992 was retrospectively studied.
- Long-term follow-up (3-20 years post-operation) included clinical interviews and examinations for 27 patients.
- Anorectal manometry was performed on consenting patients with persistent issues.
Findings:
- Nearly half of the patients (48%) experienced soiling or chronic constipation despite initial successful continence acquisition.
- Anorectal manometry revealed anorectal dyssynergies in 4 out of 9 evaluated patients.
- No significant differences were noted in malformation type, initial treatment, or follow-up between continent and incontinent groups.
Implications:
- Continence problems are not uncommon in the long-term management of low anorectal malformations.
- Routine, long-term clinical surveillance is advised for all children with LAM.
- Post-continence anorectal manometry may aid in identifying underlying functional abnormalities.
Background:
Low anorectal malformations are considered to be a benign type of anorectal malformations. Their treatment is simple in the neonatal period and gives good results as far continence is concerned.
Methods:
We studied a group of 55 boys with low anorectal malformations which had been surgically treated between the 1st January 1975 and the 31st December 1992. We studied the initial treatment and the associated anomalies, 5 patients have died. 27 were seen for an interview and a clinical examination. Extra investigations (anorectal manometry or electromyography of external sphincter) were only offered to consenting patients with an ongoing problem.
Results:
3 to 20 years had passed since their operations. Associated anomalies had been found in 11 children. The initial treatment was a perineal procedure in 20 cases and a colostomy in 8 cases. Dilatations were carried out on 11 children. Faecal and urinary continence had been acquired before 30 months of age. 13 children (48%) had problems of soiling and/or chronic constipation. There was no difference between these children and the 14 continent ones regarding the type of malformation, the initial treatment and the follow-up. Anorectal manometry (performed on 9 cases) showed 4 anorectal dyssynergies. It was normal in 3 cases. The Recto Anal Inhibitory Reflex was always present.
Conclusion:
Problems of continence are not rare in the evolution of low anorectal malformations. We suggest therefore a long-term clinical follow-up for those children, with one anorectal manometry control being performed after continence is acquired.