Revision Surgery in the Management of Anorectal Malformations: Experience from a Tertiary Center of India

Overview

Journal J Indian Assoc Pediatr Surg

Specialty Pediatrics

Date 2018 Jul 28

PMID 30050264

Citations 2

Authors

Basant Kumar

Vijai Dutta Upadhyaya

Manish Kumar Gupta

Srinivasa Kishore

J B Nijagal Mutt

Rajanikant Yadav

Sheo Kumar

Affiliations

Soon will be listed here.

Abstract

Aim And Objectives: Despite the significant advancements in the management of anorectal malformations (ARMs), there are various surgical and functional complications reported. Complications are closely related with the surgical techniques adopted and the types of malformations. In this article, we present our experiences with ARM patients who required reoperation after unsuccessful previous surgeries or who had developed complications related to the previous surgical techniques.

Materials And Methods: We retrospectively reviewed clinical and electronic records of all the patients with ARM who were operated for ARMs in our institute from June 2010 to May 2016. All ARM patients who needed reoperation were included in the study. These patients were previously operated outside our institute and referred to us with ongoing problems of constipation, stool impaction with overflow incontinence, perineal soiling, and difficult urination.

Results: There were 31 patients (M:F = 2.1:1) of ARM, reoperated for 38 indications during the above-mentioned period. Five patients had more than one problem. Presentation included neoanal stenosis (11), complete obliteration of neoanus (2), malpositioned neoanus (2), persistent/recurrent rectourethral fistula (3), iatrogenic rectovaginal fistula (4), rectal prolapse (5), large widened neoanus with soiling (2), and urethral stricture (2), which required revision interventions. Six patients had megarectum. All patients showed improvement in their symptoms after revision surgery, but 10 (41.7%) patients required further regular bowel management program (BMP) to avoid the soiling and constipation. Fourteen (58.3%) patients stayed clean without regular BMP.

Conclusion: All these complications had clear explanations and are well described in the literature. Revision surgery in such patients had fair outcome, but some sort of BMP was required. Both posterior sagittal anorectoplasty and anterior sagittal anorectoplasty are excellent techniques for revision surgery with few simple modifications.

Citing Articles

Application of trinity new model home nursing in postoperative management of children with Hirschsprung's disease.

Liu Q, Ji C, Sun Y, Wan S, Yang H, Peng X Am J Transl Res. 2021; 13(8):9152-9159.

PMID: 34540030 PMC: 8430190.

Constipation after surgery for anorectal malformations: Unrecognised problem until it is a problem.

Upadhyaya V, Bharti L, Mishra A, Yousuf M, Mishra P, Kumar B Afr J Paediatr Surg. 2021; 18(1):67-71.

PMID: 33595546 PMC: 8109748. DOI: 10.4103/ajps.AJPS_63_20.

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