8107620373

Folia Medica Lodziensia, 2011, 38:167-176

Is rectoperineal fistula in anorectal malformations an ectopic anal canal with an internal anal sphincter?

Czy przetoka odbytniczo-kroczowa w wadach odbytu i odbytnicy jest ektopowym kanałem odbytu ze zwieraczem wewnętrznym odbytu?

JERZY NIEDZIELSKI¹, JÓZEF KOBOS²

Department of Pediatrie Surgery and Urology.

Department of Pathology of the Age of Development,

Konopnicka Memoriał Hospital,

Medical University of Lodź, Poland

Abstract

Authors tried to determine the role of an internal anal sphincter (IAS) in patients with rectoperineal fistula undergoing PSARP, with orwithout IAS saving procedurę.

Materials and methods: 20 girls and 6 boys with rectoperineal fistula undergoing PSARP between 1993-2008 were included in the study. An IAS saving operation was performed in 19 children (73.1%), 17 girls and 2 boys, while 7 children underwent regular PSARP with resection of narrowed distal portion of fistula.

Results: Functional postoperative result according to the „10” score was good (8-10 pts.) in all 26 children. There was no significant difference in RAP (16.3 vs. 16.9 vs. 17.2 cmH₂0) and ACL (1.7 vs. 1.7 vs. 1.9 cm) values between children with and without preserved IAS and the reference group. Positive RAIR was observed in 13 of 19 children with preserved IAS, and in 2 of 7 patients after resection of IAS, but this incidence did not differ statistically (p = 0.095). The major functional disorder in the examined children was constipation, observed in 9 children after sphincter-saving procedurę and in 2 patients after regular PSARP, but the difference was not significant (p = 0.658).

Conclusions: An IAS is important, but not a decisive factor in fecal continence and IAS-saving procedures are associated with high incidence of constipation. Authors suggest that IAS can be spared, wherever it was possible, i.e. the fistula is wide (at least 8 mm) and it will not impair function of the neoanus.

Key words: anorectal malformations, rectoperineal fistula, internal anal sphincter, anorectal manometry, posterior sagittal approach.

Streszczenie

Autorzy podjęli próbę oceny roli zwieracza wewnętrznego odbytu (ZWO) u pacjentów z przetoką odbytniczo-kroczową po operacji wady odbytu metodą PSARP, z wycięciem lub oszczędzeniem ZWO.