Faecal Continence in Anorectal Malformation, a Correlation with Preoperative and Postoperative Parameters

Abstract

BACKGROUND Anorectal malformations are one of the most common congenital defects encountered in paediatric surgery. Operative procedures aim in attaining bowel control which implies the ability to detect and retain flatus and stool until the appropriate time for evacuation. The study aims to determine the fecal continence in anorectal malformation and its correlation with few preoperative and postoperative parameters. METHODS 60 patients who had completed surgery for anorectal malformation and on follow up in department of Paediatric Surgery, Medical College Kottayam were studied in terms of vertebral anomalies, type of fistula, surgical procedure, position of anus and functional results. Functional results were assessed by Kelly score. RESULTS Kelly's score showed that cases treated with PSARP (26.7%) had fair scores. SPM had good score in 28.6%, fair in 50% and poor in 21.4%. Skeletal anomalies was seen in 16% cases of which 90% had only fair scores. Score was good for anocutaneous fistula and vestibular fistula. All bladder neck fistulas and bulbar fistulas had fair scores (100%) while for prostatic fistula, the scores was good in 6.7%, fair in 73.3% and poor in 20% CONCLUSIONS Kelly's scoring showed inadequate stooling outcome scores in cases with vertebral anomalies, prostatic fistulas. Scores were fair following PSARP, while in SPM the cases were seen in all groups-good, fair and poor. Many of the patients had improvement in their scores when specific intervention was implemented and thus will improve their quality of life.