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Redo posterior sagittal anorectoplasty for lateral mislocation in patients with anorectal malformations
Hira Ahmad1, Devin R Halleran1, Elias Maloof1
1Department of Pediatric Colorectal and Pelvic Reconstruction Surgery, Nationwide Children's Hospital, Columbus, OH.
Insights
Re-do anorectoplasty for anorectal malformation (ARM) can address rectal mislocation. A new midline surgical technique improved functional outcomes, with most patients achieving continence and voluntary bowel movements.
Area of Science:
- Pediatric surgery
- Colorectal surgery
- Congenital anomalies
Background:
- Anorectal malformation (ARM) repair can lead to persistent soiling or constipation.
- Rectal and anal mislocation outside the muscle complex is a cause for reoperation in ARM patients.
Purpose of the Study:
- To evaluate outcomes of re-do anorectoplasty for lateral rectal mislocation.
- To introduce a novel surgical technique for correcting rectal mislocation in ARM.
Main Methods:
- Retrospective review of pediatric patients undergoing re-do anorectoplasty between 2014-2019.
- Analysis of surgical indications and patient outcomes.
Main Results:
- Twelve patients with lateral rectal mislocation underwent reoperation without immediate complications.
- 90% of patients achieved continence, and 40% gained voluntary bowel movements post-surgery.
Conclusions:
- Lateral rectal mislocation is a correctable cause of functional deficits after ARM repair.
- A midline surgical approach repositioning the rectum and neo-anus within the muscle complex shows promise for improving functional outcomes.
Background:
Children undergoing repair of an anorectal malformation (ARM) may have persistent soiling and/or constipation postoperatively. An anatomic reason should be sought; one of the causes for these problems that may require reoperation is mislocation of the rectum and anus outside of the muscle complex.
Methods:
We reviewed our population of children who underwent re-do anorectoplasty surgery between 2014 and 2019. Indications for surgery and outcomes were recorded.
Results:
Twelve patients had a lateral mislocation and underwent reoperation. There were no immediate complications in this subgroup. 9 of 10 patients are clean, and 4 are now able to have voluntary bowel movements.
Conclusion:
For patients who are found to have a significant lateral mislocation, we describe a new surgical technique that replaces the rectum and neo-anus directly in the midline through the muscle complex which may improve functional outcome.
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