Fecal Incontinence after Posterior Sagittal Anorectoplasty – Follow up of 2 years

Harjai, MM; Puri, Bipin; Vincent, P; Nagpal, BM

doi:10.1016/s0377-1237(03)80004-7

Cited by 4 publications

(2 citation statements)

References 7 publications

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“…On this issue there are different standpoints of different authors. Traditionally, it has been said that one has to wait 12 to 13 years before one can have a real evaluation of patients subjected to a repair of an anorectal malformation [18]. On the other hand Kiely and Pena do not believe that children have better fecal control as time passes [19].…”

Section: Chartmentioning

confidence: 99%

Late Diagnosis of Anorectal Malformations in Children

Statovci¹,

Grajçevci²,

Berisha³

et al. 2015

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Anorectal malformations (ARM) include a wide spectrum of congenital defects of the anus, anal canal and rectum, which are often associated with congenital anomalies of other organ systems. They appear with different clinical presentations ranging from simple imperforate anal membrane to very complex defects. They are usually detected immediately after birth or early at neonatal age, but some patients with the milder defects are diagnosed at a later age. Objectives: The aim of this study is to analyze the incidence of patients with ARM diagnosed after neonatal period, clinical features and consequences of delayed diagnosis. Materials and Methods: Since 2010 we performed a combined retrospective and prospective analysis of a total of 76 patients with anorectal malformations, diagnosed and treated at our clinic between 2005 and 2014. We analyzed patients' age at the time of diagnosis, sex, type of defect, associated anomalies and postoperative functional outcome. Results: 18 patients with ARM (23.68%) were diagnosed beyond the neonatal period. Of them 11 were female (61.11%) and 7 male patients (38.89%). The earliest diagnosed patient was a male of three months of age, while the latest diagnosed patient was a female of 8.5 years of age. All patients had low type anomalies, presented with anal stenosis (16), perineal fistula (1) and vestibular fistula (1). Six patients (33.33%) were also diagnosed with associated anomalies. Conclusion: High incidence of delayed diagnosis of ARM highlights the importance of a careful, comprehensive clinical examination of the perineum of newborns. All patients with severe and chronic constipation must be evaluated for eventually missed diagnosis of low type anorectal malformations.

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Section: Chartmentioning

confidence: 99%

Late Diagnosis of Anorectal Malformations in Children

Statovci¹,

Grajçevci²,

Berisha³

et al. 2015

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“…The prevalence of fecal and urinary incontinence following posterior sagittal anorectoplasty for anorectal malformation has been widely observed and assessed, with many variations; according to a study by Ghorbanpoor et al, good fecal continence was observed in 91.3% of patients with low type anorectal malformation compared to 72.8% of patients with high type anorectal malformation; however, the difference was not significant [ 13 ]. Furthermore, researchers discovered that incontinence was less common in low abnormalities and more common in high or intermediate anomalies, whereas constipation was more common in low anomalies and less common in high and intermediate anomalies, according to Harjai et al Thirty-one percent of the patients born with anorectal abnormalities who had posterior sagittal anorectoplasty (PSARP) were completely continent, 38% experienced fecal soiling, and 31% had constipation difficulties [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

A Review of Diagnosis and Management: Persistent Cloaca Treated by a Posterior Sagittal Approach With a Normal Functional Outcome

Wael¹,

Abuarafeh²,

Lubbad³

et al. 2022

Cureus

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Cloacal malformation (CM) is a severe, complex, and extremely rare category of anorectal and urogenital tract malformations. Prenatal diagnosis is illusory and vague; therefore, magnetic resonance imaging (MRI) is the most effective test point toward an accurate diagnosis. Thus, careful investigation and evaluation are mandatory since they could be associated with syndromes and other anomalies, including urogenital tract, vertebral, and cord abnormalities. Despite the severity and complexity of the deformity, CM cases are curable, not desperate, and can have an excellent prognosis with great surgical correction. However, managing persistent cloaca necessitates a careful assessment because corrective surgeries require inclusive surgical planning, multidisciplinary, expert, and highly specialized medical center. In surgically repaired malformations, fecal and urinary incontinence has been a major issue, which was resolved when Dr. Pena Alberto suggested safer dissection and less harmful techniques for neurovascular structures and great functional corrected anomaly to ensure fertility and less incontinence. For improved results and prognosis on quality of life, patients should be scheduled for extended bowel training along with the clinical evaluation follow-up. In this article, we present a case successfully treated with the posterior sagittal approach, Pena operation, and anorecto-vagino-urethroplasty with feminizing clitoroplasty and highlight the value and impact of prenatal evaluation, diagnosis, and management. The rarity of the case and excellent results, including fair to normal bowel and urinary control, prompted us to report it and assert the significance of assessment, surgical management and technique, challenges, postoperative bowel training, and clinical investigation and examination.

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