Clinical and manometric postoperative evaluation of posterior sagital anorectoplasty (PSARP) in patients with upper and intermediate anorectal malformations
Keywords:
Anorectal malformations, Posterior sagital anorectoplastyAbstract
PSARP is currently the most widely-used surgical technique for surgical correction of high and intermediary anorectal malformations, but there is much controversy in the literature about the postoperative evaluation of these cases. We studied 27 cases of anorectal malformations operated with PSARP from clinical and manometric aspects in order to analyze: 1) fecal continence; 2) the relationship between fecal continence and the associated sacral anomalies and; 3) the relationship between the postoperative manometric evaluation and fecal continence. From the analysis of 27 cases of high and intermediary anorectal malformations, we concluded that: 1) fecal continence was achieved in 48.14 percent of the cases; partial fecal continence in 25.92 percent; and fecal incontinence in 25.92 percent of the cases; 2) the presence of fecal incontinence was directly related to the association of sacral anomalies and; 3) anorectal manometry is a useful test to evaluate the patients operated by PSARP, due to the existence of a relationship between the manometric results and the degree of fecal continence.
Downloads
References
Peña A, De Vries SPA. Posterior sagital anorectoplasty:important technical considerations and new applications. J Pediatr Surg 1982; 17(6):796-811.
Martins JL, Pinus JQ, Pinus J. Manometria anorretal. In: Penna, FJ, Wheba J, Fagundes Neto U, eds. Gastroenterologia Pediátrica, 1st ed. Ed. Rio de Janeiro: Medi Si, 1983:641-50.
Martins JL, Pinus JQ, Pinus J. Manometria anorretal. In: Penna, FJ, Wheba J, Fagundes Neto U, eds. Gastroenterologia Pediátrica.2nd ed. Ed. Rio de Janeiro: Medsi, 1991:805-11.
Martins JL, Pinus JQ, Pinus J. Nova aparelhagem para manometria anoretal de tecnologia brasileira. Rev Paul Ped 1990;8(30):108-10.
Martins JL. Avaliação pós-operatória de crianças portadoras de anomalias anorretais, submetidas a correção cirúrgica pela anorretoplastia sagital posterior. Tese de Docência Livre, Escola Paulista de Medicina, 1993:111.
Siegel S. Estadistica no parametrica. Mexicol: Ed. Trillas, 1975:346.
Schnaufer L, Talbert JL, Haller A, Reid NCRW, Tobon F, Schuster MM. Differential sphincteric studies in diagnosis of ano-rectal disorders of childhood. J Pediatr Surg 1967; 2(6):538-43.
Eisner M. Functional examination of rectum and anus in normals, in disturbances of continence and defecation and in congenital malformations. Scand J Gastroentero 1972;7:305-08.
Ahran P, Faverdin C, Thouvenot J. Anorectal motility in sick children. Scand J Gastroenterol 1972;7:309-34.
Ahran P, Faverdin C, Devroede G, Dubois F, Coupris L, Pellerin D. Manometric assessment of continence after surgery for imperforate anus. J Pediatr Surg 1976;11(2):157-66.
Iwai N, Ogita S, Kida M, Fugita Y, Magima S. A clinical and manometric correlation for assessment of postoperative continence in imperforate anus. J Pediatr Surg 1979;14(5):538-43.
Nagasaki A, Ikeda K, Hayashida Y, Sumitomo K, Sameshima S. Assessment of bowel control with anorectal manometry after surgery for anorectal malformation. Pap J Surg 1983;14(3):229-34.
Gil-Vernet Hughet JM, Bardji Pascual C, Boix-Ochoa J. Utilidad clinica de la manometria anorrectal en la edad pediatrica. An Esp Pediatr 1985;22(4):299-305
Holschneider AM, Freeman NV. Anatomy and function of the normal rectum and anus. In: Stephens, FD, Smith, ED, eds. Anorectal Malformations in Children: update 1988. Birth Defects: Original article series, 1988;24(4):125-54.
Haberkorn S, Crispin A, Nixon HH. Assessment of fecal incontinence by means of manometry and defecogram. J Pediat Surg 1974;9:43-7.
Mischalany H, Suzuki H, Yokoyama J. Report on the First International Symposium of Anorectal Manometry. J Pediat Surg 1989; 24(4):356-59.
Martins JL, Pinus J. Anorectal manometry in the child assessment of 1,153 examinations performed from 1987 to 1995. Rev Hosp S Paulo-Esc Paul Med 1995:6(3/4):80-2.
Martins JL, Pinus J. Computerized anorectal manometry in the pediatric patient. Initial experience. Rev Hosp S Paulo-Esc Paul Med 1995:6(3/4):83-6.
Stephens FD, Smith ED. Anorectal malformations in children. Chicago:Year Book Medical Publisher,1971.
Holschneider AM. Treatment and fuctional results of anorectal continence in children with imperforate anus. Acta Chir Belg 1983;83:191-204.
Scharly AF, Kiesewetter WR. Imperforate anus: anorectosigmoid pressure studies as a quantitative evolution of postoperative continence. J Pediatr Surg 1969;4:694-704.
Gil-Vernet Hughet JM, Sanchis LF, Marhuenda C, Gimenez AI. Incontinencia de feces derivada de la atresia rectal. Cir Ped 1988;1(2):69-84.
Martins JL. Complicações no tratamento das anomalias anorretais. In: Margarido NF, Saad R., Cecconello I. Martins JL, Soares LA, eds. Complicações em Cirurgia. 1st Ed. Robe Livraria Ed., 1992:297-313.
Olness K, Mc Parland FA, Pipper J. Biofeedback: a new modality in the management of children with fecal soiling. J Pediatr 1980;96(3):505-9.
Gil-Vernet Hughet JM, Perez J, Broto J, Casasa, JM, Boix-Ochoa J. Utilidad y evaluacion del biofeedback post anorrectoplastia sagital posterior. Cir Ped 1990;3(3):130-5.
Smith ED. The bath water needs changing, but don't throw out the baby: an overview of anorectal anomalies. J Pediatr Surg 1987;22(4):335-48.
