Outcome of children operated for congenital anorectal malformations: A prospective single center study
Iranian Journal of Pediatric Surgery,
Vol. 3 No. 2 (2017),
21 January 2018
Introduction: Anorectal malformations (ARM) have an incidence of 1 in 5000 live births and affect male and female almost equally. Operative correction of pediatric ARM is of potential clinical interest; however, longterm outcome of patients in respect to probable complications requires precise follow up and surveillance. The aim of our study was to assess the outcomes of children undergoing surgical correction of ARMs.
Materials and Methods: In a prospective follow-up study, we wanted to assess occurrence of incontinence, constipation, soiling, abdominal distension, diarrhea, stenosis, dilated sphincter and failure to thrive (FTT) in ARM patients. In addition, management of these conditions has been discussed. Reoperations have also been reviewed. The primary outcome of the study was determination of occurrence of incontinence at follow-up visits. Secondary outcomes were occurrence of constipation, anal stenosis, soiling, abdominal distension, dilated sphincter, diarrhea and FTT at followup visits. In addition, the decision of research team on patients at followup visits was considered as secondary outcomes.
Results: Two hundred and ninety patients were studied. Of the study patients, 174 (60.4%) were boys and 114 (39.6%) were girls. Mean age of boys was 4.8 ± 2.0 years and mean age of girls was 5.0 ± 2.0 years. The mean follow-up period of our patients was 39.5 ± 29.1 months. During the study follow-up period, 63 patients (21.7%) had complications. The most common complication was constipation. It was present in 21 patients (33.3%). Soiling, incontinence, dilated sphincter, FTT, stenosis, abdominal distension and diarrhea were present in 21 (33.3%), 11 (17.5%), 9 (14.3%), 6 (9.5%), 6 (9.5%), 5 (7.9%), 3 (4.8%) and 2 (3.3%) patients respectively.
Conclusion: We found that the most common complications following ARM surgery are constipation, soiling, incontinence, dilated sphincter, FTT, stenosis, distension and diarrhea. The overall complication rate was 21.7%. 7.2 % and 3.1% of study population experienced constipation and incontinency respectively. In 3.1% of the study population reoperation was required. We revealed that outcome of surgical correction of ARMs is considerably good and complication rates are acceptable. Continence rate was also acceptable.
- Anorectal malformation
- Congenital anomaly
How to Cite
Hackam DJ, Grikscheit T, Wang K, Upperman JS, Ford HR. Pediatric Surgery. In: Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews, JB, Pollock RE (eds). Schwartz’s Principles of Surgery, McGraw-Hill, New York, USA, 2015, pp. 1626-7.
Fabbro MA, Chiarenza F, D'Agostino S, Romanato B, Scarpa M, Fasoli L, Iannucci I, Pinna V, Musi L. Anorectal malformations (ARM): quality of life assessed in the functional, urologic and neurologic short and long term follow-up. Pediatr Med Chir. 2011 Jul-Aug;33(4):182-92.
Huang CF, Lee HC, Yeung CY, Chan WT, Jiang CB, Sheu JC, Wang NL, Lin JR. Constipation is a major complication after posterior sagittal anorectoplasty for anorectal malformations in children. Pediatr Neonatol. 2012 Aug;53(4):252-6.
Demirogullari B, Ozen IO, Karabulut R, Turkyilmaz Z, Sonmez K, Kale N, Basaklar AC. Colonic motility and functional assessment of the patients with anorectal malformations according to Krickenbeck consensus. J Pediatr Surg. 2008 Oct;43(10):1839-43.
Rintala RJ, Lindahl HG. Fecal continence in patients having undergone posterior sagittal anorectoplasty procedure for a high anorectal malformation improves at adolescence, as constipation disappears. J Pediatr Surg. 2001 Aug;36(8):1218-21.
Rintala R, Lindahl H, Marttinen E, Sariola H. Constipation is a major functional complication after internal sphincter-saving posterior sagittal anorectoplasty for high and intermediate anorectal malformations. J Pediatr Surg. 1993 Aug;28(8):1054-8.
Stenström P, Kockum CC, Emblem R, Arnbjörnsson E, Bjørnland K. Bowel symptoms in children with anorectal malformation - a follow-up with a gender and age perspective. J Pediatr Surg. 2014 Jul;49(7):1122-30.
Senel E, Akbiyik F, Atayurt H, Tiryaki HT. Urological problems or fecal continence during long-term follow-up of patients with anorectal malformation. Pediatr Surg Int. 2010 Jul;26(7):683-9.
Ardelean MA, Bauer J, Schimke C, Ludwikowski B, Schimpl G. Improvement of continence with reoperation in selected patients after surgery for anorectal malformation. Dis Colon Rectum. 2009 Jan;52(1):112-8.
Nam SH, Kim DY, Kim SC. Can we expect a favorable outcome after surgical treatment for an anorectal malformation? J Pediatr Surg. 2016 Mar;51(3):421-4.
Julià V, Tarrado X, Prat J, Saura L, Montaner A, Castañón M, Ribó JM. Fifteen years of experience in the treatment of anorectal malformations. Pediatr Surg Int. 2010 Feb;26(2):145-9.
Hassett S, Snell S, Hughes-Thomas A, Holmes K. 10-year outcome of children born with anorectal malformation, treated by posterior sagittal anorectoplasty, assessed according to the Krickenbeck classification. J Pediatr Surg. 2009 Feb;44(2):399-403.
Paidas CN. Fecal incontinence in children with anorectal malformations. Semin Pediatr Surg. 1997 Nov;6(4):228-34.
Tannuri AC, Ferreira MA, Mathias AL, Tannuri U. Long-term evaluation of fecal continence and quality of life in patients operated for anorectal malformations. Rev Assoc Med Bras (1992). 2016 Sep;62(6):544-552.
Grano C, Aminoff D, Lucidi F, Violani C. Long-term disease-specific quality of life in children and adolescent patients with ARM. J Pediatr Surg. 2012 Jul;47(7):1317-22.
Bai Y, Yuan Z, Wang W, Zhao Y, Wang H, Wang W. Quality of life for children with fecal incontinence after surgically corrected anorectal malformation. J Pediatr Surg. 2000 Mar;35(3):462-4.
Schmiedeke E, Zwink N, Schwarzer N, Bartels E, Schmidt D, Grasshoff-Derr S, Holland-Cunz S, Hosie S, Jablonka K, Maerzheuser S, Reutter H, Lorenz C, Jenetzky E. Unexpected results of a nationwide, treatment-independent assessment of fecal incontinence in patients with anorectal anomalies. Pediatr Surg Int. 2012 Aug;28(8):825-30.
Grano C, Bucci S, Aminoff D, Lucidi F, Violani C. Does mothers' perception of social support mediate the relationship between fecal incontinence and quality of life of the child? Pediatr Surg Int. 2013 Sep;29(9):919-23.
Labouré S, Besson R, Lamblin MD, Debeugny P. Incontinence and constipation after low anorectal malformations in a boy. Eur J Pediatr Surg. 2000 Feb;10(1):23-9.
Mathias AL, Tannuri AC, Ferreira MA, Santos MM, Tannuri U. Validation of questionnaires to assess quality of life related to fecal incontinence in children with anorectal malformations and Hirschsprung's disease. Rev Paul Pediatr. 2016 Jan-Mar;34(1):99-105.
Kaselas C, Philippopoulos A, Petropoulos A. Evaluation of long-term functional outcomes after surgical treatment of anorectal malformations. Int J Colorectal Dis. 2011 Mar;26(3):351-6.
Filho HS, Mastroti RA, Klug WA. Quality-of-life assessment in children with fecal incontinence. Dis Colon Rectum. 2015 Apr;58(4):463-8.
Rigueros Springford L, Connor MJ, Jones K, Kapetanakis VV, Giuliani S. Prevalence of Active Long-term Problems in Patients With Anorectal Malformations: A Systematic Review. Dis Colon Rectum. 2016 Jun;59(6):570-80. 2013;29(9):919-23.
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