Related Experiment Videos
Anterior resection for megarectosigmoid in congenital anorectal malformations
M R Hallows1, A D Lander, J J Corkery
1Department of Paediatric Surgery, The Birmingham Children's Hospital NHS Trust, and The University of Birmingham, Birmingham, England.
Insights
Resecting dilated distal bowel effectively treats severe constipation and soiling in children with prior anorectal malformation surgery. This safe procedure significantly improves bowel function and reduces the need for laxatives and enemas.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Colorectal Surgery
Background:
- Anorectal malformations (ARMs) can lead to complex functional issues, including unmanageable constipation and soiling.
- Previous surgical interventions for ARMs may not fully resolve distal bowel dilatation, contributing to persistent symptoms.
- Megarectosigmoid, a dilated distal bowel segment, poses challenges in managing fecal incontinence and constipation.
Purpose of the Study:
- To evaluate the efficacy of resecting dilated distal bowel in pediatric patients with refractory constipation or soiling post-anorectal malformation surgery.
- To assess the safety and functional outcomes of anterior resection for megarectosigmoid in this patient population.
Main Methods:
- A retrospective review of 9 children who underwent surgical excision of dilated distal bowel.
- The surgical technique involved anastomosing normal caliber bowel to the rectal reservoir at the peritoneal reflection.
- Follow-up data on clinical outcomes, complications, and need for supportive therapies were analyzed.
Main Results:
- All 9 children experienced improvement in bowel function following the resection.
- Pre-operative symptoms included fecalomas (7/9) and soiling (7/9), with reliance on laxatives, washouts, or enemas.
- Post-operatively, children had improved bowel actions, reduced soiling, and a significant decrease in the need for laxatives, washouts, and enemas. No major complications were reported.
Conclusions:
- Anterior resection of megarectosigmoid is a safe and effective surgical option for children with persistent constipation and soiling after anorectal malformation repair.
- This procedure offers significant functional improvement, reducing the burden of supportive bowel management.
- The technique addresses the underlying anatomical issue of distal bowel dilatation, leading to better continence and evacuation.
Purpose:
The aim of this study was to review the effectiveness of resecting dilated distal bowel in children suffering unmanageable constipation or soiling who have been operated on previously for anorectal malformations.
Methods:
A retrospective review was performed of 9 children. Each child underwent excision of dilated bowel to leave normal caliber bowel anastomosed by hand to a rectal reservoir at the peritoneal reflection. The documented follow-up was reviewed.
Results:
The 9 children had primary surgery for the following anomalies: high (n = 1), intermediate (n = 1), low (n = 3), rectal stenosis (n = 3), and anal stenosis (n = 3), Seven children had persistent fecalomas, and 7 had major problems with soiling. All were on large doses of laxatives, with 5 having regular rectal washouts and 4 having regular enemas. In all radiologic studies there was a prompt change from normal caliber bowel to dilated bowel at the upper limit of the dilatation. The mean age at operation for excision was 4 years, 11 months (range, 11 months to 9 years, 11 months). The mean period of follow-up was 4 years, 7 months (range, 2 years, 3 months to 10 years). Follow-up showed that all children improved. None had major complications. All were having between one and 3 bowel actions per day. Three continued to soil but improved. Of the remaining 6, only 2 required occasional laxatives and had regular spontaneous bowel actions without soiling. No child was having enemas or washouts.
Conclusion:
Anterior resection for the treatment of megarectosigmoid is a safe and effective procedure.