Continence after posterior sagittal anorectoplasty

Langemeijer, Richard A.T.M.; Molenaar, Jan C.

doi:10.1016/0022-3468(91)90713-4

Cited by 94 publications

(39 citation statements)

References 12 publications

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“…The results have been reported to be good by some authors who conclude that normal bowel function after internal sphincter-saving PSARP may be expected in a significant proportion of children with high or intermediate anorectal anomalies [8]. On the other hand, few authors feel that although PSARP provides a good aesthetic result, patients will never acquire normal continence [9]. But this bias opinion could be avoided if the results are being evaluated by a separate team not involved in that surgery, as we have done in our study.…”

Section: Discussionmentioning

confidence: 99%

Management of anorectal malformations in Varanasi, India: a long-term review of single and three stage procedures

et al. 2005

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To compare the results of the staged procedure (Group A) with the primary single stage posterior sagittal anorectoplasty (PSARP) procedure (Group B) for high and intermediate anorectal anomalies. Four hundred ninety cases of primary single stage procedure done over a period of seven years (1996-2003) were compared with 458 out of 763 cases of staged procedure (Historical control) that underwent all three stages done from 1989 to 1996. Two hundred cases that had been in regular follow up in Group A and 254 cases in Group B who had attained three years of age were evaluated for continence by Kelly's method. The approximate cost of treatment was also calculated. Continence was good in 90 cases (45%), fair in 66 cases (33%) and poor in 44 cases (22%) in Group A while it was good in 204 cases (80% ), fair in 38 cases (15%) and poor in 12 cases (5%) in Group B. In Group A, the mortality was high as only 40% cases completed all the three stages of operation. The mortality was 4.5% in Group B. Primary PSARP is recommended as the better treatment option for intermediate and high-anorectal anomalies with superior results in terms of morbidity, mortality, continence and cost.

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Section: Discussionmentioning

confidence: 99%

Management of anorectal malformations in Varanasi, India: a long-term review of single and three stage procedures

et al. 2005

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“…In spite of the recent advances in operative techniques, the long-term prognosis in intermediate and high type ARM remains poor. Thirty to fifty-six percent of patients have significant faecal soiling after surgery [1,3,4]. Post-operative bowel management programme (BMP) including dietary advice, toilet training [5], medications [6], rectal or antegrade colonic enema [7,8] was useful in maintaining bowel continence in these children.…”

Section: Introductionmentioning

confidence: 99%

Electrical stimulation and biofeedback exercise of pelvic floor muscle for children with faecal incontinence after surgery for anorectal malformation

et al. 2006

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We report our experience of electrical stimulation and biofeedback exercise of pelvic floor muscle for children with faecal incontinence after surgery for anorectal malformation (ARM). Electrical stimulation and biofeedback exercise of pelvic floor muscle were performed on children with post-operative faecal soiling following repair of intermediate or high type ARM. Children under the age of 5 years or with learning difficulties were excluded. They had 6 months supervised programme in the Department of Physiotherapy followed by 6 months home based programme. Bowel management including toilet training, dietary advice, medications and enemas were started before the pelvic floor muscle exercise and continued throughout the programme. Soiling frequency rank, Rintala continence score, sphincter muscle electromyography (EMG) and anorectal manometry were assessed before and after the programme. Wilcoxon signed rank test was performed for statistical analysis. From March 2001 to May 2006, 17 children were referred to the programme. Twelve patients (M:F = 10:2; age = 5-17 years) completed the programme. There was a trend of improvement in Rintala score at sixth month (p = 0.206) and at the end of programme (p = 0.061). Faecal soiling was significantly improved at sixth month (p = 0.01) and at the end of the programme (p = 0.004). Mean sphincter muscle EMG before treatment was 1.699 microV. Mean EMG at sixth month and after the programme was 3.308 microV (p = 0.034) and 3.309 microV (p = 0.002) respectively. After the programme, there was a mean increase in anal sphincter squeeze pressure of 29.9 mmHg (p = 0.007). Electrical stimulation and biofeedback exercise of pelvic floor muscle is an effective adjunct for the treatment of faecal incontinence in children following surgery for anorectal malformation.

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“…[27][28][29] Rectosphincteric reflex was found in 17.1% of the 82 patients examined. When the patient groups were analyzed separately, we observed that rectosphincteric reflex was detected in 35.5% of the continent children, 4.8% of the partially continent and 6.7% of the incontinent children, i.e.…”

Section: Resultsmentioning

confidence: 99%

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

2007

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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.

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Continence after posterior sagittal anorectoplasty

Cited by 94 publications

References 12 publications

Management of anorectal malformations in Varanasi, India: a long-term review of single and three stage procedures

Management of anorectal malformations in Varanasi, India: a long-term review of single and three stage procedures

Electrical stimulation and biofeedback exercise of pelvic floor muscle for children with faecal incontinence after surgery for anorectal malformation

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

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