Fecal Incontinence after Posterior Sagittal Anorectoplasty for Anorectal Malformation: A Single-Center Study

Abstract

Background Fecal incontinence is one of the worst functional complications of posterior sagittal anorectoplasty for treatment of anorectal malformation. Objectives In this study, we aimed to identify the prevalence of fecal incontinence in patients with the diagnosis of high or low anorectal malformation who underwent three-stage posterior sagittal anorectoplasty surgery in our center. Patients and Methods Children with the diagnosis of anorectal malformation who underwent posterior sagittal anorectoplasty at the Department of Pediatric Surgery of Besat Hospital, Hamadan University of Medical Sciences, Iran, from 2012 to 2016 were enrolled in the study. Parents or guardians were recruited and asked to fill the study questionnaire including the Templeton and Ditesheim Scoring System to assess the status of fecal continence of the patients. Results Thirty-four patients including 10 (29.4%) males were enrolled in the study. High type of anorectal malformation was diagnosed in 23 (67.6%) patients. The overall mean scores of fecal continence were 4.57 ± 0.84 (range 1.5–5) after a mean follow-up time of 50.7 (range 22.5–69.8) months. Good fecal continence was observed in 91.3% of patients with low type compared to 72.8% of patients with high type of anorectal malformation; however, the difference was not significant (P=0.13). Conclusion Posterior sagittal anorectoplasty surgery in patients with anorectal malformation may result in acceptable fecal continence.

Using Odih-Score (Modified Klotz Score) for quality of defecation after anorectal malformation following posterior sagittal anorectoplasty (PSARP): Study of validation

“…The Klotz score is a widely used scale based on previous studies. 16,17 Odih-Score is a modified version of the Klotz score, which is known for its ease of use among clinicians, particularly at Arifin Achmad Hospital. The Odih-Score consists of 5 items, 4 of which are borrowed from the Klotz score, and 1 new item added.…”

Analysis of postoperative complications in children treated for moderate to severe anal atresia with laparoscopic versus open surgery: A retrospective study

“…Fecal incontinence is another common postoperative complication, which has a severe effect on the quality of life of children. [ 18 ] Most scholars believe that the cause of postoperative fecal incontinence depends on the congenital development conditions of the external anal sphincter and pelvic floor muscles; Whether the rectum was anastomosed in the center of the pelvic floor striated muscle complex; The size of the trauma to the pelvic floor muscles during the surgery. [ 19 ] The incidence of postoperative fecal incontinence in the LAARP group was significantly lower than that in the PSARP group, which validated the superiority of the laparoscopic techniques in the management of pelvic floor compared with open surgery.…”

Management of post‐surgical faecal incontinence due to anorectal malformations by pelvic floor rehabilitation

“…Recent literature have reported the desirable results of using electrical stimulation with intra‐rectal probes and, or PFM training for treatment of FI in adult patients 16,17 . Hence there is a little document for treatment of post‐surgical FI in children with ARM by pelvic floor rehabilitation approaches.…”

“…Recent literature have reported the desirable results of using electrical stimulation with intra-rectal probes and, or PFM training for treatment of FI in adult patients. 16,17 Hence there is a little document for treatment of post-surgical FI in children with ARM by pelvic floor rehabilitation approaches. In prior studies, electrical stimulation therapy was performed by an intra-rectal probe, whereas surface electrodes were used for our patients.…”