Long-term evaluation of fecal continence and quality of life in patients operated for anorectal malformations

Abstract

Summary Introduction: Patients operated for correction of anorectal malformations (ARM) can develop fecal incontinence, constipation, and soiling, with loss in quality of life. Objective: To evaluate, through the use of questionnaires, fecal continence, and quality of life of children in the late postoperative follow-up of ARM correction, both high and low. In addition, the levels of fecal continence and quality of life were compared with those of a control group. Method: A Fecal Continence Index Questionnaire (ICF) and a Questionnaire for Assessment of Quality of Life Related to Fecal Continence in Children and Adolescents (QQVCFCA) were administered to 63 patients with ARM, aged from 7 to 19 years, whose surgical treatment had been completed for at least 6 months. The patients were compared to a control group of 59 children. Results: In the control group, 25 (42.4%) patients had good continence and 34 (57.6%), normal continence. We found that the quality of life in children with ARM is compromised globally, in all areas and in the ICF questionnaire, compared to controls (p<0.001). There was no difference between patients with high and low defects. Thirty-two (50.8%) patients had other associated anomalies. Conclusion: In patients operated for ARM correction, quality of life and ICF were compromised, and there was no difference between patients with high-type and low-type of the disease. In about half the cases there are other associated malformations.

Health-Related Quality of Life and Psychosocial Morbidity in Anorectal Malformation and Hirschsprung's Disease

“…No differences in both physical and psychosocial aspects of HrQoL were found in patients with complex/high-type versus less complex/low-type ARM. [41][42][43] Correspondingly, the phenotype of HD had no effect on the disease-specific HrQoL in two single-center cohort studies comparing patients with short, long, and total colonic aganglionosis. 28,44 In contrast, others suggest that the length of the aganglionic segment influences the disease-specific HrQoL in later life.…”

“…þ No effect [41][42][43] þ No effect 28,44 À Altered HrQoL in patients with extended aganglionosis due to impaired bowel function 33,37,39 Enterostomy No data À Lower HrQoL 39 Associated anomalies…”

“…Accordingly, numerous studies recommend to increase the patients' self-awareness since a better understanding of the disease and acceptance of limitations can help the patient to overcome difficulties within daily life and to be more cooperative with necessary medical interventions. 13,27,40,42 Second, several studies have addressed the crucial role of coping strategies in ARM/HD families. Coping strategies are cognitive and behavioral modalities employed to manage the negative impact of stressful situations, first described by Lazarus and Folkman.…”

“…Finally, the lack of transition from pediatric surgical care to adult health care compromises the long-term HrQoL of patients. 39,42,70 Therefore, routine follow-up from childhood to adulthood as well as early and professional psychological support with future needs in adolescence/adulthood are strongly recommended. 28,41,71…”

Management of postoperative fecal incontinence by pediatric surgeons in Nigeria: a pilot study

“…Fecal incontinence is a much larger problem than reported [9], and it is associated with impairment of several domains of quality of life measures [3,13]. The impact on the quality of life is similar in patients treated either for anorectal malformation or Hirschsprung disease [3].…”