[Evaluation of late results in the children with anorectal anomalies].

UNLABELLED

Anorectal malformations constitute the most varied group of congenital defects. Constant challenge for the surgeon being engaged in this subject are the studies of new factors which could improve the functional results of treatment.

AIM

The aim of the study was the evaluation of late results after surgical treatment in children with anorectal anomalies. Assessment of the qualification criteria for the kind of surgical repair: one-stage (OSR) or stage repair (SR), age of the patient at the end of treatment and accompanying sacral bone defects were taken into consideration as the factors of functional prognosis.

MATERIAL AND METHODS

93 children with different types of anorectal defects were operated on between 1990-2002 in Department of Pediatric Surgery in the Institute of Mother and Child. The evaluation was performed in 60 patients over 3 years old: in 30 after OSR (group I) and in 30 after SR proceeded by colostomy (group II). Anorectal malformations were classified according to Pena's division based on the place of fistula orifice. Most kinds of anorectal anomalies were operated on according to the principles of posterior sagital anorectoplasty (PSARP). In patients with congenital anal stenosis a modified cutback procedure was done. In long-term evaluation in every child precise diagnostics of sacral bone with definition of congenital sacral bone defects and sacral measurements were performed, in order to estimate their influence on the results of treatment of anorectal anomalies. In postoperative evaluation of functional results the following criteria were taken into consideration: physical examination, evaluation of fecal continence by using quantitative scoring method and manometric study. The control group included 20 children with constipation.

RESULTS

Sacral bone defects were diagnosed in 10% of the OSR group (group I) and in 73% of patients of the SR group (group II). Sacral measurements showed significant differences in SR group compared with OSR and control group. In clinical examination postoperative appearance of perineal and anal region depended on congenital development of perineal structure. In ST group of patients symptoms of 'flat perineum' were seen with various degree of muscles hypodevelopement, lack of perineal raphe and weakly marked anal dimple. Results of fecal continence in OSR group (group I) were defined as normal in 93% of patients and good in 7% of cases. In SR group (group II) the results were as following: normal in 41%, good in 17%, fair in 38% and poor in 4% of cases. The worst results were obtained in the patients with sacral defects in SR group. In manometric study there were no significant differences except for one parameter (anal resting pressure) between OSR group (group I) and the control group. In group II manometric study was different in three parameters: anal resting pressure, squeezing pressure and presence of internal sphincter reflex. The presence of sacral bone defects had the most important influence on manometric study results.

CONCLUSION

Functional results in the OSR group of patients were not different from the control group. Precise criteria for this kind of surgical treatment and lack of serious sacral defects were the most important factors for good prognosis. The results of late evaluation in SR group depended on coexisting sacral bone agenesis.