Long-term follow-up of anorectal malformation – how long is long term?

Bhojwani, Rajesh; Ojha, Sunita; Gupta, Rajkumar; Doshi, Dharmil

doi:10.1097/01.xps.0000529797.96055.cc

Cited by 4 publications

(10 citation statements)

References 12 publications

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“…Тому частина пацієнтів через певний час перестає брати участь у ВМР. За даними деяких авторів, близько 50% пацієнтів із часом перестають брати участь у ВМР [2,18,21,30]. Водночас у разі повного дотримання пацієнтів і батьків програми управління кишечником, позитивний ефект вдається отримати у 95% випадків (що виражається в контролі дефекації, діти не мають каломазання між застосуванням клізм) [2,7,20,29,30].…”

Section: результати дослідження та їх обговоренняunclassified

“…За даними деяких авторів, близько 50% пацієнтів із часом перестають брати участь у ВМР [2,18,21,30]. Водночас у разі повного дотримання пацієнтів і батьків програми управління кишечником, позитивний ефект вдається отримати у 95% випадків (що виражається в контролі дефекації, діти не мають каломазання між застосуванням клізм) [2,7,20,29,30]. Більшість експертів також відмічають суттєве зниження показань до хірургічного лікування в разі дотримання ВМР [3,21].…”

Section: результати дослідження та їх обговоренняunclassified

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Diagnosis and treatment of fecal incontinence after surgical correction of congenital anocolorectal pathology in children

Fofanov¹,

Yurtseva²,

Fofanov³

et al. 2022

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Fecal incontinence (FI) in children is a serious medical and social problem. FI leads to severe limitations in a child’s development and social adaptation. Pediatric surgeons mainly deal with the mechanical type of FI that occurs after surgical correction of anorectal malformations (ARM) or Hirschsprung's disease (HD). Violation of defecation control is observed in 53-89% of patients who underwent surgery for ARM and HD. Purpose - to study the causes and effectiveness of the proposed complex treatment of FI in children operated on for HD and ARM. Materials and methods. Clinical examination and treatment of 92 children with congenital pathology of the distal colon and anus (55 (59.78%) patients with HG and 37 (40.22%) with ARM) was carried out at the Pediatric Surgery Clinic of Ivano-Frankivsk National Medical University. Among the surveyed children were 64 boys and 28 girls (ratio - 2.29:1). In terms of age, newborns and children of the first year of life predominated among those who underwent primary surgery - 57 (61.95%) children. FI of varying severity was detected in 48 (52.17%) patients operated on for HD and ARM at different terms after surgical correction - from 6 months to 3 years. The types, causes, and severity of FI in each child were studied. In addition to conventional clinical and instrumental studies, patients underwent anoscopy and rectoscopy, transanal ultrasound, anorectal manometry. The severity of AI was assessed on a S.D. Wexner score. Results. FI occurred in 34 (70.8%) children after HD correction and in 14 (29.2%) patients after ARM surgery. True FI was found in 33 (68.75%) children. Pseudoincontinence was detected in 15 (31.25%) patients it was more common in patients operated on for HD. For conservative treatment of patients with FI a Bowel Management Program was implemented. In 24 (50.0%) patients treated according to this program, the control of defecation was significantly improved, the incontinence severity index was significantly reduced according to the Wexner score. In true AI due to severe anal sphincter damage, we performed minimally invasive surgical correction of postoperative insufficiency or congenital defect of the internal sphincter of the anus using a volume-forming implant in 14 (29.17%) children. Immediate and long-term results of the operation were good, which was reflected in improved control of defecation, a significant increase of basal pressure and a decrease of the incontinence severity index. Conclusions. Tactics of the FI treatment depends on the cause and severity. The implementation of the Bowel Management Program can significantly improve the control of defecation and improve the quality of life of patients. In case of insufficiency of the internal anal sphincter, minimally invasive correction by anal submucosal implantation of a volume-forming gel is effective. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Keywords: fecal incontinence, anorectal malformations, Hirschsprung's disease, children.

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Section: результати дослідження та їх обговоренняunclassified

Diagnosis and treatment of fecal incontinence after surgical correction of congenital anocolorectal pathology in children

Fofanov¹,

Yurtseva²,

Fofanov³

et al. 2022

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“…According to some studies in developed countries, the QoL of children after de nitive surgery for ARMs does not signi cantly differ from that of healthy children (12). Some patients however experience lowered social, physical, emotional, and cognitive functioning (10,13,14), hence the need for long-term follow-up (15). Even after de nitive surgery, approximately 47.7% of children develop complications (4).…”

Section: Introductionmentioning

confidence: 99%

“…This is more common with high and complex types of ARMs that lead to poor functional outcomes with regards to fecal continence and constipation, with subsequent poor QoL (6, 14). In the long-term, QoL outcomes can be improved following improvement in continence and appropriate surgical interventions, which are possible through involvement in a structured bowel management program (15). Despite the high burden of ARMs, limited research has been conducted about QoL in Africa.…”

Section: Introductionmentioning

confidence: 99%

Quality of Life of Children After Completion of Surgical Treatment for Anorectal Malformation: A Single-Centre Cross-Sectional Study in South-Western Uganda

Mucunguzi,

Oyania,

Egesa

et al. 2023

Preprint

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Background Anorectal malformations (ARMs) range from minor abnormalities such as imperforate anus to complex forms such as cloaca, and are often associated with other anomalies and residual functional stooling problems. The present study aimed to evaluate the quality of life (QoL) of children after surgical treatment for ARMs at Mbarara Regional Referral Hospital (MRRH) in South-Western Uganda. Methods In this cross-sectional study, we enrolled children who had completed surgical treatment for ARMs between 2014 to 2021 at MRRH. A 23-item PedsQL 4.0 inventory was used to evaluate health-related QoL in children using a multidimensional parent proxy reporting for children aged 3 months to 7 years and child self-reporting for children aged 8 to 17 years. Regression analysis was used to determine the association between sociodemographic and clinical variables and QoL. Crude and adjusted coefficients and their corresponding 95% confidence intervals (CI) were calculated. The significance level was set to a p-value < 0.05. Results A total of 88 participants (F:M ratio = 1.15:1) aged 3 months to 18 years with a median age of 4.5 (IQR 3–7) years were enrolled. The median age at diagnosis of ARM and preliminary diverting colostomy was 3 days (range: 2 to 30 days) and 3 days (range: 2 to 60 days) respectively. Rectovestibular fistulas, 47 (53.4%) were the most prevalent subtype of ARMs, and 5.7% of children had associated anomalies. Over one-third of the participants (38.6%) had definitive surgery after 3 years of age, and PSARP was the most common procedure. The average PedsQL score was 94 out of a maximum score of 100. The mean physical functioning score was 96.7 in males and 98.9 in females. The overall mean emotional functioning score was 91 ± 2. The mean social functioning score was 92 ± 3.0. The mean school functioning score was 95.7 in males and 98.5 in females. Associated anomalies and reoperation significantly predicted poor QoL. Increasing years after completion of surgery was significantly associated with good QoL scores. Conclusion The overall QoL of the participants was good. Associated anomalies and reoperation were associated with poor QoL, while years after completion of definitive surgery was associated with good QoL. There is need for increased awareness and utilization of QoL assessments as an outcome measure after definitive surgery for ARM.

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“…Зарубежные коллеги выделяют ранние послеоперационные осложнения -стеноз ануса (14-16 %), раневую инфекцию (7-24 %), ректальный пролапс (3,8-27 %), рецидивирующие ректо-урогенитальные свищи (1-16 %), задний дивертикул уретры (остаточная кишечная культя -2 %) [5,[9][10][11]. Неудовлетворительные функциональные результаты (запор, недержание и псевдонедержание кала) относят к поздним осложнениям комплексного (оперативного и консервативного) лечения и их считают основной составляющей низкого уровня качества жизни подрастающих детей с АРМ [12,13].…”

Section: Introductionunclassified

Errors and сomplications in the treatment of children with anorectal malformations

Pimenova

Сергеевна²,

Tarasova

et al. 2021

Russian Journal of Pediatric Surgery, Anesthesia and Intensive

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Purpose. This manuscript aims to introduce errors and complications of diagnosis and treatment in children with anorectal malformations (ARM). Methods. A retrospective analysis of 63 children with ARM treated at a single tertiary Speransky childrens Hospital. Results. The patients ages ranged from 2 mo to 17 y. o. (median, 6 y. o.). The types of ARM included: rectourethral fistula 27%, rectoperineal fistula 17.5%, rectovestibular fistula 15.9%, rectobladderneck fistula 6.3%, no fistula 7.9%, cloaca 11.1%, cloaca with urogenital sinus and disorder of sex development 1.6%, pouch colon 1.6%, rectal stenosis 4.8%, anal duplication 3.2%, and rectovaginal fistula 3.2%. Of these patients, 76% underwent surgery earlier at another hospital (surgical treatment completed), 14% had stomas, and 10% did not have any prior procedures. The historical analysis showed diagnostic errors in 48% of children (untimely diagnosis, incorrect interpretation of the ARM variant, prolonged delay in anorectoplasty). Errors led to emergency procedures or changes in subsequent surgical treatment (further ostomy, excess bowel resection) in 22% of cases. After anorectoplasty (stenosis, mislocated anus/rectum, rectal prolapse), complications were detected in 56% of cases, whereas ostomy complications were observed in 5% of cases. Long-term problems after the surgical treatment (constipation, incontinence, and pseudoincontinence) were evident in 98% of children. Different surgical reconstructive techniques of the sphincter formation had been performed previously in 13% of patients. Moreover, they most often had spinal pathology as the cause of functional disorders. Only half of the childrens parents had information about bowel management, 38% did not follow the recommendations and usually had fecal impaction and pseudoincontinence. 45% of children/parents performed non-effective or irregular enemas and required corrective treatment. Conclusion. It is recommended that Russian pediatric surgeons treat children with ARM, according to Russian pediatric surgeons guidelines consistent with international protocols to avoid errors and complications.

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Long-term follow-up of anorectal malformation – how long is long term?

Cited by 4 publications

References 12 publications

Diagnosis and treatment of fecal incontinence after surgical correction of congenital anocolorectal pathology in children

Diagnosis and treatment of fecal incontinence after surgical correction of congenital anocolorectal pathology in children

Quality of Life of Children After Completion of Surgical Treatment for Anorectal Malformation: A Single-Centre Cross-Sectional Study in South-Western Uganda

Errors and сomplications in the treatment of children with anorectal malformations

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