scholarly journals Clinical evaluation of fecal continence after posterior sagittal anorectoplasty in anorectal abnormalities

2004 ◽  
Vol 57 (5-6) ◽  
pp. 284-288 ◽  
Author(s):  
Svetlana Bukarica ◽  
Smiljana Marinkovic ◽  
Vesna Zrnic-Pekovic ◽  
Dusanka Dobanovacki ◽  
Vladimir Borisev ◽  
...  
Keyword(s):  
Clinical Evaluation ◽  
Surgical Procedure ◽  
Anorectal Malformations ◽  
Fecal Continence ◽  
Posterior Sagittal Anorectoplasty ◽  
Perineal Fistula ◽  
Secondary Procedure ◽  
Rectal Atresia ◽  
Vestibular Fistula ◽  
Bowel Movements

Introduction Posterior sagittal anorectoplasty (PSAKP) was introduced in 1982, by Repa and de Vries, as a new surgical procedure for patients with anorectal malformations. It was supposed to provide better chance for normal fecal continence. Meterial and methods Between 1991 and 2000, 50 patients with anorectal abnormalities underwent PSARP. In 43 patients PSARP was primary operation and in 7 it was a secondary procedure. At the time of study patients were not younger than 3, and not older than 13 years. Patients and their parents were interviewed, and fecal continence was graded as follows: voluntary bowel contractions, soiling less than once a week, soiling more than once a week, daily soiling and constipation. Results Amongst patients who underwent primary surgical correction, 74% had voluntary bowel contractions. Babies with perineal fistula, rectal atresia and stenosis presented with best results in term of voluntary bowel contractions (100%), as with vestibular fistula, ten of eleven patients. Only 18% of patients (atresia without fistula, vestibular fistula and bulbourethral fistula) had soiling. Patients with perineal fistula and rectal atresia and stenosis 40% were totally continent (voluntary bowel movements without soiling). The most frequent sequel was constipation, which appeared in 48%, without coincidence with frequency of soiling. The problem of constipation was surprisingly more frequent in patients with expected better prognosis in fecal continence. Conclusion Although PSARP offers a good esthetic result, only two third of patients have voluntary bowel movements and in about half there exists a problem with constipation, with necessary further treatment.

scholarly journals The analysis of continence after posterosagital anorectoplasty in anorectal malformation patients in Wahidin Sudirohusodo hospital of Makassar

2019 ◽  
Vol 7 (6) ◽  
pp. 2022
Author(s):  
Alwi Lawile ◽  
Farid Nur Mantu ◽  
Nita Mariana ◽  
Arifin Seweng
Keyword(s):  
Gender Differences ◽  
Medical Records ◽  
Anorectal Malformation ◽  
Anorectal Malformations ◽  
Posterior Sagittal Anorectoplasty ◽  
Perineal Fistula ◽  
Cross Sectional ◽  
Cross Sectional Design ◽  
The One

Background: The management of anorectal malformations universally uses posterior sagittal anorectoplasty (PSARP) as standard surgery. The aim of this research was to determine continence in patients with anorectal malformation after PSARP action.Methods: This study was a descriptive analytical categorical research with cross sectional design. The data were obtained from patients’ medical records and questionnaire given to patients underwent PSARP in Wahidin Sudirohusodo Hospital and network hospitals from June 1 to December 1, 2018. The analysis was done to 60 children ranging from 5 to 8 years old. Most of them were male (56.7%) ranging from 5 to 6 years old (53.3%).Results: The results of the research indicated that based on malformation subtype, most of them suffered from rectourethra fistula (40.0%) with continence problem (61.7%). There was no significant correlation between sex and continence problem (p >0.05). However, it was seen that the percentage of continence subjects was higher in female (65.4%) than in male (58.8%), while the percentage of soiling and constipated subjects was higher in male than in female. Rectourethra fistula was found more frequently in male than in female (70.6%), while vestibuler fistula was found more frequently in female (69.2%). There was no significant correlation between age and defecation problem (p >0.05). However, the percentage of continence and soiling subjects was higher in 5-6 years children then the one for 7-8 year children, while the percentage of constipated subjects was higher in 7-8 year children (21.4%) than 5-8 year children (18.8%).Conclusions: Gender differences in the outcome of children with anorectal malformations must be considered. Men with perineal fistula were likely to experience continence and constipation than women with perineal fistulas. Women with perineal fistulas and vestibular fistulas had almost similar outcome.

scholarly journals Anorectal malformation with long perineal fistula: one of a special type

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Sen Li ◽  
Jun Wang
Keyword(s):  
Anorectal Malformation ◽  
Bowel Function ◽  
Anorectal Malformations ◽  
Contrast Enema ◽  
Posterior Sagittal Anorectoplasty ◽  
Function Score ◽  
Perineal Fistula ◽  
Definitive Surgery ◽  
Inhibitory Reflex

AbstractThe anorectal malformation with long perineal fistula is a rare anomaly in the spectrum of anorectal malformations. Aim of the study is to describe the series of patients with anorectal malformation with long perineal fistula and compare the outcome with patient with standard perineal fistula. From March 2012 to January 2019, 7 patients who suffered from anorectal malformation with long perineal fistula were retrospectively reviewed. Three were operated on primarily by our department, and 4 cases were re-operated after a perineal anoplasty repair performed elsewhere. Four were operated by laparoscopy assisted anorectoplasty, and 3 cases were repaired by posterior sagittal anorectoplasty. The follow-up outcomes were compared with 71 cases of normal perineal fistula (NPF) in the same period. 7 cases have been followed up for 0.5–4 years (M = 2.57 ± 1.26) after definitive surgery. Their bowel function score was lower than normal perineal fistula (SPF = 12, range: 5–18; NPF = 18.5, range: 18–20). Four cases underwent anorectomanometry. The incidence of rectoanal inhibitory reflex was lower in the special type group. (p = 0.14). Three cases of contrast enema using barium: 2 cases of colorectal dilatation and thickening changes, 1 case showed no obvious abnormalities. Anorectal perineal fistula should be examined by distal colostogram at preoperation. This should be altered in: When suspecting a case of anorectal malformation type long perineal fistula a preoperative contrast enema could give insight of the anatomy befor performing a anoplasty.

scholarly journals Descriptive Epidemiology of Anorectal Malformations in Chinese Population

2017 ◽  
Vol 6 (4) ◽  
pp. 74
Author(s):  
Christoph Heinrich Houben ◽  
Kin Wai Edwin Chan ◽  
Kit Yi Kristine Pang ◽  
Xiang-Nan Feng ◽  
Wai Cheung Jennifer Mou ◽  
...  
Keyword(s):  
Chinese Population ◽  
Death Rate ◽  
Anorectal Malformations ◽  
Vacterl Association ◽  
Descriptive Epidemiology ◽  
Referral Centre ◽  
Tertiary Referral ◽  
Perineal Fistula ◽  
Tertiary Referral Centre ◽  
Vestibular Fistula

Over a twelve year period one hundred and five neonates (30 females) with an anorectal malformation (ARM) were studied at a tertiary referral centre in Hong Kong. A perineal fistula was the most frequent presentation of ARM in males closely followed by rectourethral fistula. Vestibular fistula was the most common anomaly amongst females. An ARM without a fistula was documented in 11 % of patients and dominated by males. Associations and syndromes were present in nearly 30 % of the group with VACTERL association and Down syndrome at the forefront. Isolated anomalies were most frequently seen in the renal tract (23 %), the CNS (20 %) and the heart (18 %). A quarter of the cohort was small for gestational age with syndromes/associations featuring in half of this subgroup. A death rate of 9.5 % was recorded, of which all except one had an underlying syndrome or association. In addition a pre-existing heart condition constituted the most significant factor affecting the mortality in 50 % of this group.

scholarly journals Perineal Fistula With High Dilated Colon: One of a Special Type of Anorectal Malformations

2020 ◽  
Author(s):  
Sen Li ◽  
Jun Wang
Keyword(s):  
Bowel Function ◽  
Anorectal Malformations ◽  
Posterior Sagittal Anorectoplasty ◽  
Function Score ◽  
Perineal Fistula ◽  
Defecation Function ◽  
Definitive Surgery ◽  
Inhibitory Reflex

Abstract Background The perineal fistula with high dilated colon is a rare anomalous in the spectrum of anorectal malformations. The aim of this study is to explore the diagnosis and treatment of this special type of perineal fistula (SPF), and to avoid the severe consequence due to misdiagnosis.Methods From March 2012 to January 2019, 7 patients who suffered from perineal fistula with high dilated colon were retrospectively reviewed. Three were operated on primarily by our department, and 4 cases were re-operated after a perineal anoplasty repair performed elsewhere. Four were operated by laparoscopic anorectoplasty (LARP), and 3 cases were repaired by posterior sagittal anorectoplasty (PSARP). The follow-up outcomes were compared with 71 cases of normal perineal fistula (NPF) in the same period.Results 7 cases have been followed up for 0.5-4 years (M=2.57±1.26) after definitive surgery. Their bowel function score (BFS) was lower than normal perineal fistula (SPF=12, rang:5-18; NPF=18.5, rang:18-20). Four cases underwent anorectomanometry. The incidence of rectoanal inhibitory reflex (RAIR) was lower in the special type group. (p=0.14). Three cases of barium enema angiography: 2 cases of colorectal dilatation and thickening changes, 1 case showed no obvious abnormalities.Conclusions Anorectal perineal fistula should be examined by distal colostogram at preoperation. Select appropriate surgical approach is essential for children’s defecation function, and blind surgery can seriously affect long-term defecation function.

scholarly journals The outcome of two stage repair in anorectal malformations with rectovestibular fistula.

2020 ◽  
Vol 27 (07) ◽  
pp. 1527-1532
Author(s):  
Shafiq ur Rehman ◽  
Yasir Makki ◽  
Fareena Ishtiaq ◽  
Saad Fazal ◽  
Nauman Aziz ◽  
...  
Keyword(s):  
Wound Infection ◽  
Age Distribution ◽  
Bowel Function ◽  
Anorectal Malformations ◽  
Anal Stenosis ◽  
Posterior Sagittal Anorectoplasty ◽  
Two Stage ◽  
Stoma Formation ◽  
Vestibular Fistula ◽  
Protective Colostomy

Wound infection and dehiscence after recto vestibular fistula repair may affect the fecal continent mechanisms. A significant number of children with anorectal malformations have long term social, economic and psychological problems due to fecal incontinence. The role of protective colostomy should not be under estimated especially when you are treating the children from poor socioeconomic settings with compromised nutritional status. Objectives: The aim of this study was to evaluate the outcome of two stage limited posterior sagittal anorectoplasty with protective colostomy in female patients of congenital recto vestibular fistula. Study Design: Prospective study. Settings: Department of Pediatric Surgery, DHQ Teaching Hospital Sahiwal. Period: January 2016 to December 2018. Material & Methods: Thirty four girls with anorectal malformation and recto vestibular fistula underwent two stage anorectoplasty. Divided sigmoid colostomy and limited posterior sagittal anorectoplasty was performed in first stage. Six to eight weeks later stoma was closed in second stage. All the patients were evaluated for fecal continence, constipation, bowel function and complications of stoma formation, definite procedure and stoma closure. Results: The age distribution of patients at the time of surgery ranged from 9 months to 5 years (mean 27.32 months). During the first stage of repair, three patients (8.82 %) developed wound infection. Mucosal prolapse was seen in two patients (5.88%). Anal stenosis was noticed in one patient (2.94%). Seven patients (20.58%) developed peri stoma skin excoriation. Stoma prolapse was observed in three patients (8.82%). Four patients (11.76%) developed wound infection after colostomy closure. During the follow up period, constipation was reported in five patients (14.70%) and soiling in one patient (2.94%). Conclusion: Two stage correction of congenital recto vestibular fistula under the cover of colostomy is safe strategy. It is strongly recommended in a setup with limited resources and weak infrastructure. It is also useful for patients from poor socioeconomic settings.

scholarly journals Posterior sagittal anorectoplasty in anorectal anomalies: clinical, manometric and profilometric evaluation

2007 ◽  
Vol 125 (3) ◽  
pp. 163-169 ◽  
Author(s):  
Pedro Félix Vital Júnior ◽  
José Luiz Martins ◽  
Fábio Luís Peterlini
Keyword(s):  
Prospective Study ◽  
Anorectal Malformations ◽  
Voluntary Contraction ◽  
Fecal Continence ◽  
Similar Distribution ◽  
Posterior Sagittal Anorectoplasty ◽  
Anorectal Anomalies ◽  
Mean Pressure ◽  
Resting Pressure ◽  
Excellent Method

CONTEXT AND OBJECTIVE: Anorectal malformations comprise a spectrum of anomalies that continue to be difficult to treat, even today. The aim was to evaluate the fecal continence of children who underwent posterior sagittal anorectoplasty due to anorectal malformations, via computerized anorectal manometry and profilometry. DESIGN AND SETTING: Prospective study at Universidade Federal de São Paulo. METHOD: 82 patients (56.1% boys; 43.9% girls) of mean age 85.5 months were evaluated. They were divided into continent, partially continent and incontinent groups. Age, sex, manometric variables and profilometric parameters were studied. The results were statistically analyzed. RESULTS: Among the 82 patients, 37.8% were continent, 25.6% were partially continent and 36.6% were incontinent. The overall mean resting pressure was 22 mmHg, and the means for the continent, partially continent and incontinent groups were, respectively, 30.7 mmHg, 23 mmHg and 14.7 mmHg. The overall mean pressure response to voluntary contraction was 56 mmHg, and the means for the groups were 65.4 mmHg, 55.8 mmHg and 46.6 mmHg, respectively. The rectosphincteric reflex was absent in 82.9% of the cases. In the profilometry analysis for all patients together, blue (20 to 50 mmHg) and yellow (50 to 80 mmHg) were predominant, and there was a similar distribution for the continent and partially continent patients. However, among the incontinent patients, green (< 20 mmHg) and blue prevailed. CONCLUSIONS: Manometric and computerized profilometric analyses were an excellent method for postoperative evaluations on patients with intermediate and high anorectal anomalies, and for therapeutic planning.

scholarly journals Clinical and radiological postoperative evaluation of posterior sagittal anorectoplasty in patients with upper and intermediate anorectal malformations

1997 ◽  
Vol 115 (6) ◽  
pp. 1566-1569 ◽  
Author(s):  
José Luiz Martins ◽  
Henrique Manoel Lederman ◽  
José Pinus
Keyword(s):  
Surgical Technique ◽  
Fecal Incontinence ◽  
Anorectal Malformations ◽  
Fecal Continence ◽  
Radiological Evaluation ◽  
Posterior Sagittal Anorectoplasty ◽  
Postoperative Evaluation ◽  
Operative Evaluation

The PSARP is today the most-used surgical technique for correction of high and intermediary anorectal malformations.There is much controversy in the literature about the post-operative evaluation of these cases. We studied 27 cases of anorectal malformations from clinical and radiological aspects, in order to analyse: 1. Fecal continence 2.Relationship between post-operative fecal continence and the associated sacral anomalies 3.Relationship between the radiological evaluation by defecogram and fecal continence From the analysis of the cases, we concluded: 1. Fecal continence was achieved in 48.14% of the cases; partial continence in 25.92%; and fecal incontinence in 25.92% of the cases. 2.The presence of fecal incontinence was directly related to the associated sacral anomalies.

scholarly journals LIMITATIONS OF CROSS TABLE PRONE LATERAL X-RAY/INVERTOGRAM IN DIAGNOSING OF TYPES OF ANORECTAL MALFORMATIONS

2020 ◽  
pp. 41-43
Author(s):  
Renu Kushwaha ◽  
Santosh Kushwaha ◽  
Rachna Bhatnagar ◽  
U.C Singh ◽  
Deepak Singh ◽  
...  
Keyword(s):  
Anorectal Malformation ◽  
Pediatric Surgery ◽  
Anorectal Malformations ◽  
Time Frame ◽  
Posterior Sagittal Anorectoplasty ◽  
Diagnostic Dilemma ◽  
X Ray ◽  
Medical College ◽  
Rectal Atresia ◽  
Anorectal Atresia

INTRODUCTION Anorectal malformation is the very common congenital malformation with the incidence of 1 in 5000 (1,2). The diagnosis is made on perineal examination which is further corroborated by cross table prone lateral x-ray or invertogram to find out the level of anorectal atresia. The cross table prone lateral x-ray is considered better investigation tool as compared to invertogram for demonstration of the level of rectal atresia in neonates. In prone cross table lateral x-ray, effect of gravity is negated, positioning of the baby is more comfortable and the rectal gas shadow is better delineated. AIM To evaluate the sensitivity and specificity of cross table prone lateral x-ray in labelling a patient of anorectal malformation as high or low. MATERIAL AND METHODS The study was conducted in retrospective manner. Radiological materials, clinical and operative records of the neonates with anorectal malformation operated in Department of Surgery, Pediatric Surgery unit, BRD Medical College over a period of 2 years (June 2017 to July 2019) were retrieved. Total 100 neonates with anorectal malformation were admitted in our hospital during this time frame. Out of these patients, colostomy was done in 79 patients, anoplasty was performed in 18 cases. Two patients underwent primary posterior sagittal anorectoplasty while 1 patient had ileostomy done. During this study, we came across four unusual cases of low anorectal malformation where the x-ray picture did not coincide with the clinical diagnosis. CONCLUSION Diagnosis of anorectal malformation is clinical but to diagnose the type of anorectal malformation it requires both clinical as well as radiological workup. In case of diagnostic dilemma, our clinical interpretation should lead the diagnosis as none of the x-ray modality has 100% sensitivity.

scholarly journals Role of Routine Dilatations after Anorectal Reconstruction—Comparison of Two Tertiary Centers

2018 ◽  
Vol 29 (03) ◽  
pp. 243-246 ◽  
Author(s):  
Dhanya Mullassery ◽  
Sumita Chhabra ◽  
Ashik Babu ◽  
Roberta Iacona ◽  
Simon Blackburn ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Surgical Outcomes ◽  
Anorectal Malformations ◽  
Postoperative Management ◽  
Posterior Sagittal Anorectoplasty ◽  
Anorectal Reconstruction ◽  
Definitive Surgery ◽  
The Uk

Aim Regular anal dilatations are commonly recommended in the postoperative management following posterior sagittal anorectoplasty (PSARP) in anorectal malformations (ARM). We hypothesized that routine postoperative dilatations may not affect surgical outcomes following PSARP. We compare surgical outcomes of routine postoperative dilatations versus no routine postoperative dilatations from two United Kingdom tertiary pediatric surgical centers. Materials and Methods This is retrospective records review of patients undergoing definitive surgery for ARM in two tertiary surgical centers in the UK over 5 years. Center A used a protocol of routine postoperative dilatations, and center B used a protocol, which used dilatations only for clinical indications of stricture. Data collected included ARM type, operative procedures, and postoperative interventions. All post-operative interventions under general anesthesia (GA) were compared between groups. Results From 2011 to 2015, 49 procedures (46 PSARPs) were performed in center A and 54 (52 PSARPs) in center B. Median follow up period was 31 months (interquartile range [IQR] 18–48). The first postoperative anal calibration under GA was documented for 43 (86%) patients in center A and for 42 (78%) patients in center B. Following this, center A followed routine postoperative dilatation (RPD) at home, and center B reserved further dilatations for specific indications. RPD was performed for 100% of patients in center A versus 8% in center B. Further anal dilatations under GA were performed in 19 (38%) children in center A and in 17 (34%) children in center B (p = 0.68). In center A, 10 patients (22%) needed further surgery versus 14 (28%) in center B (p = 0.48). Conclusion The use of routine postoperative dilatations does not significantly improve surgical outcomes following PSARP in ARM.

scholarly journals Anomalies Associated with Ano Rectal Malformation: Experience in Dhaka Shishu (Children) Hospital

2016 ◽  
Vol 10 (1) ◽  
pp. 23-25
Author(s):  
Md Shahjahan ◽  
Sabbir Karim ◽  
Kazi Md Noor ul Ferdous ◽  
Tariq Akhtar Khan ◽  
Md Aminur Rashid
Keyword(s):  
Congenital Anomalies ◽  
Anorectal Malformation ◽  
Craniofacial Anomalies ◽  
Perineal Fistula ◽  
Total Study Population ◽  
Female Ratio ◽  
Vestibular Fistula ◽  
Male Female Ratio ◽  
Study Population ◽  
Cloacal Anomaly

Anorectal Malformation is one of the most common congenital anomalies. It is associated with others anomalies. But those others anomalies are sometime neglected. The purpose of this study is to review the incidence of other congenital anomalies associated with anorectal malformation (ARM). This prospective study was carried out in the department of Pediatric Surgery, Dhaka Shishu (Children) Hospital during the period of June, 2013 to July, 2014. A number of 45 cases were included and data were collected on the type of ARM and associated congenital anomalies which were categorized according to organ system. Total study population was 45. Male: Female ratio was 1.37:1. Majority (55.55%) presented with ARM without fistula, followed by recto vestibular fistula 26.67%, perineal fistula 13.33%, and 2 patients had cloacal anomaly. Thirty two (71.1%) patients had associated congenital anomaly. Among them, 42%, urogenital anomalies, 37.78% cardiovascular, 20% craniofacial anomalies, 11.11% musculoskeletal and anomalies of central nervous system 11%. Among 32 patients, 57.14% patients had multiple congenital anomalies. It is imperative that a thorough clinical evaluation and systemic investigations of all patients with anorectal malformation necessary to exclude or confirm the presence of genitourinary, cardiac and other abnormalities which are directly related with mortality and morbidity.Faridpur Med. Coll. J. Jan 2015;10(1): 23-25

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