J Korean Surg Soc.  2010 Sep;79(3):223-227.

Function on Defecation after Surgical Correction in Anorectal Malformations: Results of Krickenbeck Assessment

• Cho Y
• Sim M
• Kim H

Abstract

PURPOSE
The final aim of operation for anorectal malformations (ARMs) is acquisition of normal bowel habit by preserving an anorectal function. This study was performed to assess the functional results after definite correction of the malformations.
METHODS
37 patients (Group 1) without rectocutaneous fistula and 23 patients (Group 2) with rectocutaneous fistula were Included in the study. The authors examined functional assessment of children over 3-years-old, according to Krickenbeck classification, and analyzed the results.
RESULTS
Group 1 showed significant soiling in 24.3% and constipation requiring management in 35.1%.But Group 2 showed constipation in only 8.7%. The results of Krickenbeck assessment are as follows: Group 1 showed good results in 64.9% and poor results in 35.1% with improvement over time. Group 2 showed 91.3%, 8.7%, respectively.
CONCLUSION
Constipation rather than soiling was the main functional problem after surgical repair of anorectal malformations but improved over time. It seems that more aggressive management of constipation warrants good results after definite surgical repair.

Keyword

Anorectal malformations; Defecation; Assessment

MeSH Terms

Child
Constipation
Defecation
Fistula
Humans
Soil
Soil

Reference

1. Mundt E, Bates MD. Genetics of Hirschsprung disease and anorectal malformations. Semin Pediatr Surg. 2010. 19:107–117.

2. Stephens FD, Smith ED. Classification, identification and assessment of surgical treatment of anorectal anomalies. Pediatr Surg Int. 1986. 1:200–205.

3. Holschneider A, Hutson J, Peña A, Beket E, Chatterjee S, Coran A, et al. Preliminary report on the International Conference for the Development of Standards for the Treatment of Anorectal Malformations. J Pediatr Surg. 2005. 40:1521–1526.

4. Kiesewetter WB. Imperforate anus: the role and results of the sacro-abdominoperineal operation. Ann Surg. 1966. 164:655–661.

5. Rehbein F. Imperforate anus: experiences with abdomino-perineal and abdomino-sacro-perineal pull-through procedures. J Pediatr Surg. 1967. 2:99–105.

6. Soave F. Surgery of rectal anomalies with presentation of the relationship between the colonic muscular sleeve and the puborectalis muscle. J Pediatr Surg. 1969. 4:705–712.

7. Mollard P, Soucy P, Louis D, Meunier P. Preservation of infralevator structures in imperforate anus repair. J Pediatr Surg. 1989. 24:1023–1026.

8. deVries PA, Peña A. Posterior sagittal anorectoplasty. J Pediatr Surg. 1982. 17:638–643.

9. Willitial GH. Endosurgical intrapuborectal reconstruction of high anorectal anomalies. Pediatr Endosurg Innov Tech. 1998. 2:5–11.

10. Georgeson KE, Inge TH, Albanese CT. Laparoscopically assisted anorectal pull-through for high imperforate anus--a new technique. J Pediatr Surg. 2000. 35:927–931.

11. Kubota A, Kawahara H, Okuyama H, Oue T, Tazuke Y, Tanaka N, et al. Laparoscopically assisted anorectoplasty using perineal ultrasonographic guide: a preliminary report. J Pediatr Surg. 2005. 40:1535–1538.

12. Rintala R, Lindahl H, Louhimo I. Anorectal malformations - results of treatment and long term follow-up in 208 patients. Pediatr Surg Int. 1991. 6:36–41.

13. Templeton JM Jr, Ditesheim JA. High imperforate anus--quantitative results of long-term fecal continence. J Pediatr Surg. 1985. 20:645–652.

14. Peña A. Anorectal malformations. Semin Pediatr Surg. 1995. 4:35–47.

15. 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. 28:1054–1058.

16. Demirogullari B, Ozen IO, Karabulut R, Turkyilmaz Z, Sonmez K, Kale N, et al. Colonic motility and functional assessment of the patients with anorectal malformations according to Krickenbeck consensus. J Pediatr Surg. 2008. 43:1839–1843.

17. Meier-Ruge WA, Holschneider AM. Histopathologic observations of anorectal abnormalities in anal atresia. Pediatr Surg Int. 2000. 16:2–7.

18. Gangopadhyay AN, Upadhyaya VD, Gupta DK, Agarwal DK, Sharma SP, Arya NC. Histology of the terminal end of the distal rectal pouch and fistula region in anorectal malformations. Asian J Surg. 2008. 31:211–215.

19. Lambrecht W, Lierse W. The internal sphincter in anorectal malformations: morphologic investigations in neonatal pigs. J Pediatr Surg. 1987. 22:1160–1168.

20. Kelly JH. The clinical and radiological assessment of anal continence in childhood. Aust N Z J Surg. 1972. 42:62–63.

21. Rintala RJ, Lindahl H. Is normal bowel function possible after repair of intermediate and high anorectal malformations? J Pediatr Surg. 1995. 30:491–494.

22. Liem NT, Hau BD. Long-term follow-up results of the treatment of high and intermediate anorectal malformations using a modified technique of posterior sagittal anorectoplasty. Eur J Pediatr Surg. 2001. 11:242–245.

23. Rintala R, Mildh L, Lindahl H. Fecal continence and quality of life in adult patients with an operated low anorectal malformation. J Pediatr Surg. 1992. 27:902–905.

24. Langemeijer RA, Molenaar JC. Continence after posterior sagittal anorectoplasty. J Pediatr Surg. 1991. 26:587–590.

25. 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. 44:399–403.

26. Chun YS, Kim WK, Park KW, Lee SC, Jung SE. Long-term results of imperforate anus treated by posterior sagittal anorectoplasty. J Korean Surg Soc. 2000. 59:514–518.

27. Kim WK. Posterior sagittal anorectoplasty for imperforate anus and anorectal malformations. J Korean Surg Soc. 1987. 32:344–352.

28. Rintala RJ, Lindahl HG, Rasanen M. Do children with repaired low anorectal malformations have normal bowel function? J Pediatr Surg. 1997. 32:823–826.

29. Labouré S, Besson R, Lamblin MD, Debeugny P. Incontinence and constipation after low anorectal malformations in a boy. Eur J Pediatr Surg. 2000. 10:23–29.

30. Javid PJ, Barnhart DC, Hirschl RB, Coran AG, Harmon CM. Immediate and long-term results of surgical management of low imperforate anus in girls. J Pediatr Surg. 1998. 33:198–203.