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How much do we know about constipation after surgery for anorectal malformation?

Paul Chia-Yu Chang¹, Yih-Cherng Duh², Yu-Wei Fu³

¹Division of Pediatric Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan; School of Medicine, Mackay Medical College, New Taipei City, Taiwan.

Pediatrics and Neonatology

|July 13, 2019

Summary

Constipation is common after anorectal malformations (ARM) repair. Patients with good types and no risk factors have better outcomes when weaning laxatives post-surgery.

Keywords:

anorectal malformation bowel function constipation laxative megarectosigmoid

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Area of Science:

Pediatric Surgery
Gastroenterology
Clinical Outcomes Research

Background:

Anorectal malformations (ARM) are congenital conditions requiring surgical correction.
Postoperative constipation is a significant concern following ARM repair.
Evaluating the efficacy of laxative treatment is crucial for managing constipation in these patients.

Purpose of the Study:

To assess the incidence of constipation after anorectal malformations (ARM) repair.
To determine the success rates of laxative treatment in patients with ARM.
To identify factors influencing constipation management outcomes post-ARM surgery.

Main Methods:

Prospective collection of clinical data from 84 patients with ARM between 2012 and 2017.
Patients categorized into 'good types' (e.g., rectoperineal) and 'poor types' based on ARM classification.
Risk factors for poor outcomes included spinal anomalies, low sacral ratio, or cognitive impairment; success defined by laxative tapering.

Main Results:

Constipation onset averaged 12.8 months post-reconstruction, with no significant difference between good and poor types.
In severe constipation cases (>6 months), 77.8% of good types achieved success versus 20% of poor types (p=0.02).
Patients with good types and no risk factors had a 100% success rate in weaning laxatives, compared to 55.6% with risk factors (p=0.02).

Conclusions:

Constipation frequently develops in the early postoperative period after ARM repair.
Favorable surgical types and the absence of specific risk factors predict successful laxative weaning.
These findings aid in tailoring management strategies for constipation following ARM surgery.