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Fecal Incontinence after Posterior Sagittal Anorectoplasty - Follow up of 2 years
M M Harjai1, Bipin Puri2, P J Vincent3
1Classified Specialist (Surgery & Paediatric Surgery), 166 Military Hospital, C/o 56 APO.
Insights
Fecal continence is the goal after anorectal malformation (ARM) repair. Clinical assessment revealed 31% total continence, 38% soiling, and 31% constipation in pediatric patients post-surgery.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Outcomes Research
Background:
- Fecal continence is the primary goal following surgical repair of anorectal malformations (ARM).
- Traditional manometric and radiological assessments are challenging in preschool children due to cooperation requirements.
- Clinical evaluation is crucial for assessing functional outcomes in young patients post-ARM surgery.
Purpose of the Study:
- To clinically assess constipation and incontinence in pediatric patients after definitive anorectal malformation surgery.
- To evaluate the functional outcomes of posterior sagittal anorectoplasty (PSARP) using clinical criteria.
- To highlight persistent bowel control issues impacting quality of life in children with ARM.
Main Methods:
- Retrospective clinical assessment of patients with anorectal malformations (ARM) operated between April 1998 and March 2000.
- Exclusion of patients below 4 years of age for complete continence assessment.
- Data collection focused on clinical criteria for constipation and incontinence post-definitive operation.
Main Results:
- 31% of patients achieved total fecal continence, 38% experienced soiling, and 31% presented with constipation.
- Incontinence rates were lower in low ARM anomalies compared to high or intermediate ones.
- Constipation rates were higher in low ARM anomalies and lower in high/intermediate anomalies.
Conclusions:
- Clinical assessment is vital for evaluating bowel control post-ARM surgery in young children.
- A significant proportion of patients experience ongoing issues with constipation and/or incontinence.
- Further research and long-term follow-up are necessary to improve the quality of life for children with ARM.
Abstract:
After an anorectal malformation (ARM) is repaired, the goal is fecal continence of the patient. Toilet training is not complete in children below 4 years of age. Manometric and radiological studies need cooperation of the child, and are therefore of little value during the critical preschool years. In this present study, we used only clinical criteria to assess the child for constipation and incontinence after definitive operation. We included all patients of ARM wef 01 April 1998 to 31 March 2000. Only 2 children had crossed 4 years of age at the time of this assessment and therefore it was not possible to assess total continence postoperatively. We found that the incidence of incontinence was less in low anomalies and more in high or intermediate anomalies, while the incidence of constipation was higher in low anomalies and less in high and intermediate anomalies. 31% of all patients born with anorectal malformations and subjected to posterior sagittal anorectoplasty (PSARP) approach were totally continent, 38% suffered with soiling of faeces while 31% had problems of constipation. The higher incidence of constipation as well as incontinence in our study is because of a short follow-up and secondly, these problems are known to improve with passage of time. The purpose of this article is to highlight the problems of bowel control even after the definitive operation and still much more is required to improve the quality of life of these unfortunate children.
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