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Advances in the management of anorectal malformations
1Division of Pediatric Surgery, Schneider Children's Hospital, New Hyde Park, New York 11040, USA.
Insights
Pediatric patients with anorectal malformations can achieve continence through surgical repair and bowel management programs. Long-term follow-up shows significant improvements in quality of life for most children.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Urology
Background:
- Anorectal malformations (ARMs) present ongoing challenges in pediatric surgery, often leading to fecal and urinary incontinence.
- Advances in surgical techniques, particularly the posterior sagittal approach, have improved understanding and management of ARMs.
Purpose of the Study:
- To evaluate the long-term outcomes of a large series of patients with anorectal malformations.
- To assess functional results including bowel and urinary control after surgical repair.
Main Methods:
- Retrospective review of clinical data from 1,192 patients with ARMs treated over 19 years.
- Analysis of malformation types, associated defects, and functional outcomes (bowel movements, soiling, constipation, urinary control).
Main Results:
- 75% of patients achieved voluntary bowel movements; 37.5% were totally continent.
- Constipation was the most frequent sequela; urinary incontinence was more common after cloacal repair, especially in females.
- Fecal incontinence affected 25% but improved with bowel management programs and continent appendicostomy.
Conclusions:
- Effective management strategies, including surgical repair and bowel management programs, can lead to social continence for all patients with ARMs.
- Improved quality of life is achievable through tailored management, addressing both fecal and urinary incontinence.
Background:
Anorectal malformations represent a continuing challenge for the pediatric surgeon. A significant number of these children suffer from fecal incontinence, urinary incontinence, and sexual inadequacy. However, major advances in the management of these children have occurred during the last 10 years. The posterior sagittal approach has led to a better understanding of the internal anatomy of these defects, and in turn, a more rational way to manage the patients. We present here our experience with the long-term follow-up of a large series of these patients operated on by us.
Methods:
Clinical information from our database of patients with anorectal malformations was retrospectively reviewed. A total of 1, 192 patients operated on by the authors and observed for the last 19 years are included in the database. We searched for type of malformation, associated defects, results in terms of voluntary bowel movements, soiling, constipation, and urinary control.
Results:
Globally, 75% of all patients have voluntary bowel movements. Half of this group still soils their underwear occasionally. Therefore, about 37.5% of all cases are considered totally continent. Constipation was the most common sequelae. Urinary incontinence was relatively common after the repair of cloacas. Male patients rarely suffered from urinary incontinence. Twenty-five percent of all cases suffered from fecal incontinence but they significantly improved their quality of life when subjected to a bowel management program. An operation called "continent appendicostomy" further improved their quality of life.
Conclusion:
All patients born with anorectal malformations can be kept clean of stool and dry of urine, either because they achieve bowel control or because they are subjected to a bowel management program.