Conclusions and Results of the Krickenbeck Meeting 2005

A clear recommendation concerning specific instruments cannot be derived from clinical experience or from data in the literature. To date, the Kelly score [15] has been most widely used. The Holschneider score [8] is the only one that includes an objective parameter (electromanometry) and gives more detailed information regarding bowel habits. The score introduced by Rintala and Lindahl [25] underwent a validation process and data from a control group of children with normal bowel habits are available. Quality-of-life measurement reveals the most relevant and detailed information. However, the appropriate instruments for quality-of-life measurement of children and adolescents with incontinence remain a matter of discussion.

At the Krickenbeck Meeting in 2005, consensus was achieved concerning the assessment of outcome after ARM repair (Table 27.8). The method comprises three parameters: voluntary bowel movements (yes/ no), soiling (yes/no, if yes grade 1-3), and constipa ify of life

Table 27.7 Quality-of-life scoring criteria for children (aged 8-16 years) with fecal incontinence according to Bai et al. (2000) [1]. Note that the higher the scores, the better the qual-

ify of life

Item

Criteria

Points

Soiling

Absent

4

Accidental

3

Frequent

2

Incontinence

Accidental

1

Frequent

0

School absence

Never

2

Accidental

1

Frequent

0

Unhappy or anxious

Never

2

Accidental

1

Frequent

0

Food restriction

No

2

Somewhat

1

Much

0

Peer rejection

Never

2

Accidental

1

Frequent

0

tion (yes/no, if yes grade 1-3). The assessment should be performed in children more than 3 years of age who are not undergoing therapy. The surgeon, who is involved in the treatment and follow-up of the patients who are to be scored, may bias the results of scoring. Therefore, the assessment and analysis of data should preferably be done by a person who is not involved in the treatment of the patient. This may bring pediatric surgeons closer to psychologists and methodologists, who are essential for establishing validated instruments for assessment of children and adolescents with ARM in the future.

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