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Do children with repaired low anorectal malformations have normal bowel function?
R J Rintala1, H G Lindahl, M Rasanen
1Children's Hospital, University of Helsinki, Finland.
Insights
Only half of children with low anorectal malformation achieve normal bowel function. Long-term management of constipation is crucial for these patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Urology
Background:
- Anorectal malformations (ARMs) are congenital anomalies affecting the terminal part of the gastrointestinal tract.
- Surgical repair is the primary treatment for ARM, but long-term functional outcomes, particularly bowel function, require thorough evaluation.
Purpose of the Study:
- To compare bowel function in children treated for low anorectal malformations (ARMs) with that of healthy children.
- To assess the prevalence of constipation and soiling in this patient cohort.
Main Methods:
- A multivariate scoring system based on a questionnaire was used to evaluate bowel function in 40 toilet-trained patients (median age 7 years) with low ARMs.
- Clinical outcomes were graded as excellent, good, fair, or poor.
- Fifty-four healthy children served as controls.
Main Results:
- 52% of patients with low ARMs had normal bowel function comparable to controls.
- Constipation was reported in 42% of patients versus 7% of controls.
- Daily soiling due to fecal overflow occurred in 10% of patients, with no controls reporting this issue.
Conclusions:
- Approximately half of children with low ARMs achieve age-appropriate bowel function.
- Constipation is a significant long-term issue requiring ongoing management in this population.
- Further long-term follow-up is essential for optimizing bowel management in pediatric ARM patients.
Purpose:
The authors' aim was to compare bowel function in patients who had undergone repair of a low anorectal malformation with that of normal healthy children.
Methods:
The bowel function of 40 patients (29 boys, 11 girls; median age, 7; range, 3 to 13) with low anorectal malformations was evaluated by a multivariate scoring method based on a questionnaire. All patients were toilet trained for defecation and micturition. They were also evaluated clinically, and the outcome was graded as excellent (normal bowel function), good (no or minor social limitations), fair (marked social limitations), or poor (total incontinence). Fifty-four healthy children with a similar age and gender distribution were used as controls.
Results:
Twenty-one patients (52%) with normal bowel function had continence scores within the range of the scores of healthy children (patients, 19.3 +/- 0.7 v controls, 19.1 +/- 1.3). Fifteen patients had a good clinical outcome. The mean score in this group was 16.3 +/- 2.4. Four patients with a fair outcome had a mean score of 10.5 +/- 2.9. Constipation requiring dietary or medical treatment was reported by 17 patients (42%) and four of the controls (7%). Daily soiling caused by fecal overflow was reported by four patients (10%) and none of the controls. None of the patients had urinary incontinence; occasional wetting was found in 27% of the patients and 22% of the controls (P = .56).
Conclusion:
Only half of the children with a low anorectal malformation have age-appropriate normal bowel function. Long-term follow-up of these patients to manage the main functional problem, constipation, is warranted.