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The failed anoplasty: successful outcome after reoperative anoplasty and sigmoid resection
1Division of Pediatric Surgery, Stanford University School of Medicine, Packard Children's Hospital, Palo Alto, California 94304, USA.
Insights
Children with imperforate anus who remained incontinent after initial surgery achieved full bowel control with reoperative anoplasty. This surgical approach successfully treated severe constipation and fecal incontinence, leading to improved quality of life.
Area of Science:
- Pediatric Surgery
- Colorectal Surgery
- Anorectal Malformations
Background:
- Anorectal malformations (ARMs) can lead to suboptimal outcomes, including fecal incontinence and constipation, after initial surgical repair.
- This study focuses on a cohort of patients with imperforate anus who underwent primary anoplasty in infancy but presented with complete fecal incontinence.
Observation:
- Patients presented with complete fecal incontinence, absence of voluntary bowel movements, and continuous diaper use.
- Perineal examination revealed an intact muscle complex but a malpositioned neoanus.
- Contrast enema demonstrated significant rectosigmoid dilation and fecal impaction; MRI excluded tethered spinal cord.
Findings:
- A combined reoperative anoplasty using the posterior sagittal approach and sigmoid resection was performed.
- Within six months, all patients achieved complete fecal continence.
- Post-reoperation, patients experienced one to three voluntary bowel movements daily without soiling.
Implications:
- Reoperation for fecal incontinence in ARM patients with intact muscle complexes can yield excellent functional outcomes.
- Surgical evaluation is crucial for children experiencing severe constipation and incontinence post-anoplasty.
- Correctable anatomical defects identified during re-evaluation can be addressed to improve continence.
Background/Purpose:
Children with anorectal malformations often have less than optimal results after repair. The authors report on five patients (ages 3 to 17 years) born with imperforate anus and treated with anoplasty as a newborn. At presentation, all patients were completely incontinent of stool. None had ever experienced voluntary bowel movements, and all wore diapers continuously.
Methods:
Perineal examination with the nerve stimulator showed the muscle complex was largely intact with good contraction, but the neoanus was outside of the muscle complex. Contrast enema showed massive dilation of the rectosigmoid colon and fecal impaction. A tethered spinal cord was excluded by magnetic resonance imaging (MRI). We treated these patients with a combined reoperative anoplasty via the posterior sagittal approach and sigmoid resection.
Results:
Within 6 months after the procedure, all patients had achieved complete continence. They had from one to three voluntary bowel movements per day without soiling.
Conclusions:
Children with severe constipation and fecal incontinence after anoplasty should undergo evaluation by a surgeon. If examination shows a reasonably intact muscle complex and correctable anatomic defects, an excellent result can be achieved with appropriate reoperation.