Anorectal malformations: Definitive management during and beyond adolescence

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Abstract

Aim:

To evaluate our results of definitive repair of anorectal malformations in patients with delayed presentation, during and beyond adolescence.

Material and Methods:

It is a retrospective analysis of all adolescent patients presenting for the first time for definitive repairs and innate patients - colostomy performed during the neonatal period, but who had lost to follow-up. It includes 15 patients (2 male and 13 female) aged from 13 to 32 years. Three well-decompressed female patients were managed by primary anterior sagittal anorectoplasty (ASARP). Twelve patients underwent staged procedures. Five patients (two male and three female) underwent posterior sagittal anorectoplasty (PSARP). The oldest male patient underwent abdominal-PSARP.

Results:

All of them attained socially acceptable fecal continence at follow-up of 1–4½ years. They are satisfied with the functional and cosmetic outcome of repair of their anomalies.

Conclusions:

Prospects of fecal continence are good when definitive repair of anorectal malformations is done by an expert, even in the adolescent age group and beyond.

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Most cited references 17

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Posterior sagittal anorectoplasty: important technical considerations and new applications.

Alberto A Peña, Pieter A. deVries (1982)

Posterior sagittal anorectoplasty (PSARP) is a new technique for the repair of high anorectal malformations. It is based upon complete exposure of the anorectal region by means of a median sagittal incision that runs from the sacrum to the anal dimple, cutting through all muscle structures behind the rectum. It was learned through this procedure that the external sphincter is a functionally useful prominent structure. No puborectalis sling, as such, could be identified. It was possible, however, to recognize a muscle continuity from the skin to the sacral insertion of the levator ani. Since it is impossible to pull the generally ectatic rectum through without destroying the muscle structures present, the rectum must be tapered to allow suturing the muscle behind it. In all these anomalies, the rectum and urethra (or vagina) are very closely joined, sharing a common wall, and their separation calls for extensive exposure. A number of technical details clarified in the course of applying the procedure in 54 patients are fully discussed. This approach also proved to be very successful in the management of two patients with rectocloacal fistula, two with rectal atresia and two with stenosis. Colostomy has been closed in 27 patients and fecal continence may be described as excellent, except in those patients with severe sacral anomalies, and unquestionably superior to that obtained by us with other techniques.

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Posterior sagittal anorectoplasty.

Pieter A. deVries, Alberto A Peña (1982)

From October 1980 to November 1981, 34 patients with anorectal anomalies have been operated upon by a sagittal midline approach. The skin incision extends from the sacrum to the perineum (ventral aspect of the anal dimple). The superficial and deep layers of the external sphincter are identified by electrostimulation and split, with the coccyx, in the midline. Ileo- and pubococcygeal portions of the levator dorsally and then the striated muscle complex of the external sphinctor, pubococcygeus and the presumed puborectalis are split ventrally to the urethra. In no cases has the ventral portion of the levators been separated from the thick ventral portion of the external sphincter, hence the term "striated muscle complex." When the terminal bowel is dilated (congenitally ectatic), the bowel is tailored prior to reconstruction of the sphinctors. The posterior sagittal approach provides an excellent exposure for evaluation and mobilization of the terminal bowel. It enables one to construct an anal canal, suture the bowel wall to the striated musculature and the mucosa to the skin, thereby reducing or avoiding the complications of prolapse and stenosis. In males with ectasia and a rectourethral fistula, transrectal closure of the mucosa at the fistula site, leaving the rectal longitudinal smooth muscle insertions on the prostatic capsule, avoids damage to the nerves and genital structures.

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Congenital short colon.

A. Shekhar Pandey, A Wakhlu, Veena Agarwal … (1995)

Congenital short colon (CSC) is a condition in which the colon is replaced, wholly or partially, by a dilated pouch together with anorectal malformation and a colourinary fistula. Most of the reported series have been from northern India where this malformation is frequent. This paper details the management of 108 patients with CSC over a period of 23 years. The patients were classified into two types: (1) Partial short colon, where a segment of normal colon is present between the ileum and the sac. These patients could be treated by excision of the pouch and pull-through of the segment of normal colon during either single- or two-stage surgery. (2) Complete short colon, where the ileum opened directly into the sac, and formation of a tube from this sac (coloplasty) was required in one or more stages to provide a length of normally functioning colon. Review of the results showed staged management to be superior. The follow-up has ranged between 3 and 7 years, with satisfactory long-term results in both groups of patients. We have evolved a protocol for the management of CSC that has improved the prognosis and quality of life of these patients.

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Author and article information

Journal

Journal ID (nlm-ta): J Indian Assoc Pediatr Surg

Journal ID (iso-abbrev): J Indian Assoc Pediatr Surg

Journal ID (publisher-id): JIAPS

Title: Journal of Indian Association of Pediatric Surgeons

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0971-9261

ISSN (Electronic): 1998-3891

Publication date (Print): Jul-Sep 2012

Volume: 17

Issue: 3

Pages: 120-123

Affiliations

[1]Department of Paediatric Surgery, B J Medical College, Pune, India

Author notes

Address for correspondence: Dr. Minakshi Sham, G/101, Sudarshan Apartments, Behind Spencer's Daily, Karvenagar; Pune – 411 052, Maharashtra, India. E-mail: minakshi_dr@ 123456rediffmail.com

Article

Publisher ID: JIAPS-17-120

DOI: 10.4103/0971-9261.98131

PMC ID: 3409900

PubMed ID: 22869978

SO-VID: 8da61ad3-9492-4d3a-8fa7-9879f9554a54

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Anorectal malformations: Definitive management during and beyond adolescence

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Most cited references 17

Posterior sagittal anorectoplasty: important technical considerations and new applications.

Posterior sagittal anorectoplasty.

Congenital short colon.

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