Postoperative Outcome after ARM

In 2001, Holschneider et al. [3] compared two groups of patients after ARM treatment: results achieved before the introduction of PSARP in the period 19621984 (n = 381) and those achieved after the introduction of Peñas technique (period 1985-1997; n = 197). Incontinence decreased during these two periods in high types of ARM from 55% to 24%, in intermediate types from 30% to 11%, and in low forms from 8% to zero. The frequency of partial continence increased in the same time interval from 32% to 56% in the high types and decreased from 60% to 47% in the intermediate forms. It remained unchanged at 25% and 21%, respectively, in the low malformations. Continence increased from 13.5% to 20% in high, 10% to 42% in intermediate, and 67% to 79% in low anomalies (Fig. 25.1).

The main postoperative problem in our last series from 1985 to 1997 of 197 children operated according to Peña was chronic constipation with overflow incontinence: 63.2% of the patients showed no constipation and had normal defecation habits, but 28.6% of the children were occasionally, and 8.3% always constipated. In other series too, chronic constipation is a well-known phenomenon. In 1992, Hedlund and Peña reported on 9 out of 30 severely constipated children and 6 with additional overflow soiling [10].

In 1995 Peña described his results in 285 children [4]. He observed chronic constipation to varying degrees in 61.4% with vestibular fistulae, 55.0% with bulbar fistulae, and 41.4% with prostatic fistulae. Soiling occurred in 0-82.6% of his patients depending on the type of the fistula. It is well known that vestibular, bulbar, and prostatic fistulae usually need more preparation to allow sacroperineal pull-through than do perineal and bladder-neck fistulae. Therefore, the possibility of damage to the extramural nerve supply to the rectum is higher in intermediate-type lesions than in low- or high-type malformations. On the other hand, in bladder-neck fistulae the development of the striated muscle complex is hypoplastic, favor

1962-1984 vs. 1985-1997

Fig. 25.1 Continence, partial continence, and incontinence in two groups of patients (periods 1962-1984 and 1985-1997; from Holschneider et al. 2001 [3])

ing anal incontinence as a result of a reduced anorectal pressure barrier. Therefore, soiling was observed in 82.6% of patients with bladder-neck fistulae. Bliss et al. [11] and Chau et al. [12] found similar results (Table 25.1).

In addition, chronic constipation is also an ongoing problem after repair of low ARM. In 1997 Rintala et al. [13] found constipation in 17 out of 40 (42%) children after correction of low ARM. In addition, four patients (10%) suffered from daily soiling by overflow incontinence. Only half of the children with low ARM had age-appropriate normal bowel function.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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