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Treatment and functional results of anorectal continence in children with imperforate anus
Insights
This study analyzed 172 imperforate anus patients, reporting high complication rates and significant challenges in achieving anorectal continence, particularly in high-risk groups. Surgical outcomes varied, with many patients experiencing incontinence or partial continence post-operation.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Anorectal Malformations
Background:
- Imperforate anus is a congenital condition requiring surgical intervention.
- Assessing outcomes, including complications and continence, is crucial for patient management.
- Previous studies highlight varied results and persistent challenges in achieving functional continence.
Purpose of the Study:
- To report outcomes of 172 patients with imperforate anus.
- To analyze complications, lethality, and anorectal continence after surgical repair.
- To discuss current surgical techniques for improving anorectal continence.
Main Methods:
- Retrospective analysis of 172 patients undergoing 215 operations for imperforate anus.
- Evaluation of lethality across different risk groups (A, B, C).
- Assessment of anorectal continence using Kelly score, electromanometry, and clinical evaluation.
Main Results:
- Overall lethality was 16.6%, with higher rates in high-risk groups (58% in A, 27% in B, 3% in C).
- Common complications included anal stenosis (15.5%), fistula relapse (7%), and mucosa prolapse (5%).
- Long-term continence varied: 50% of high-type and 14% of low-type imperforate anus patients remained incontinent; 15% of high and 43% of low types became continent.
Conclusions:
- Surgical repair of imperforate anus is associated with significant morbidity and variable functional outcomes.
- Achieving complete anorectal continence remains a challenge, especially in high-type malformations.
- Further research and refinement of surgical techniques are needed to improve long-term functional results and quality of life.
Abstract:
The results of 172 patients with imperforate anus are reported. In these patients 215 operations where performed. The complications, lethality and the results concerning anorectal continence are analysed. The lethality was 58% in the risk group A (high risk), 27% in group B and 3% in C group (low risk). The overall lethality was 16.6%. Specific complications were anal stenosis (15.5%), relapse of anorectal or anovaginal fistulas (7%) and mucosa prolapse (5%). Anorectal continence was evaluated according to the Kelly score of continence and to our own electromanometric and clinical score. Five years after the operation 50% of the patients with high type, and 14% of those with low type imperforate anus remained incontinent. Only 15% of the high anal atresias and 43% of the low forms became continent. Thirty-five percent of the children with a high anorectal malformation and 43% with a low type acquired a partial continence with small amounts of soiling. The current surgical techniques to improve anorectal continence are discussed: Pickrell's gracilis transplantation and its modifications, the free muscle transplantation according to Hakelius and Grotte, the free smooth muscle transplantation according to Schmidt and the reverse smooth muscle transplantation according to Holschneider and Hecker. Clinical and electromanometrical as well as electromyographical results are presented.