Long-term urologic and gynecologic follow-up and the importance of collaboration for patients with anorectal malformations

Purpose Dynamic graciloplasty (DGP) has been used to treat severe fecal incontinence since the 1980s. Previous studies have shown an inferior outcome in patients with anorectal malformations (ARMs). Our experience has been that DGP has been appreciated by ARM -patients. The objective of the study was to evaluate the long-term outcome of DGP in our patients with ARM compared with patients with other underlying conditions. Materials and Methods Twenty-three patients operated with DGP at our institution from 1996 to 2010 were sent validated bowel function and quality of life questionnaires. Eighteen of 23 responded. Seven had ARM and 11 had other etiologies of fecal incontinence. The mean follow-up time was 11.6 years (range, 5–17). Results Four of 7 of the patients with ARM and 8 of 11 of patients with other etiologies used their implants at follow-up. The Miller incontinence score was slightly higher for patients with ARMs, but they had less constipation and higher Fecal Incontinence Quality of Life (FIQL)- and 36-Item Short Form Health Survey (SF-36) scores. None of the differences were statistically significant. Conclusion This study cannot confirm earlier reports in which DGP has an inferior outcome in patients with ARM. We therefore believe that the procedure should remain a treatment option for selected patients.

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Long-term evaluation of fecal continence and quality of life in patients operated for anorectal malformations

Revista da Associação Médica Brasileira ◽

10.1590/1806-9282.62.06.544 ◽

2016 ◽

Vol 62 (6) ◽

pp. 544-552 ◽

Cited By ~ 5

Author(s):

Ana Cristina Aoun Tannuri ◽

Mariana Aparecida Elisei Ferreira ◽

Arthur Loguetti Mathias ◽

Uenis Tannuri

Keyword(s):

Quality Of Life ◽

Anorectal Malformations ◽

Fecal Continence ◽

Group Method ◽

Control Group ◽

Term Evaluation ◽

Associated Malformations

Summary Introduction: Patients operated for correction of anorectal malformations (ARM) can develop fecal incontinence, constipation, and soiling, with loss in quality of life. Objective: To evaluate, through the use of questionnaires, fecal continence, and quality of life of children in the late postoperative follow-up of ARM correction, both high and low. In addition, the levels of fecal continence and quality of life were compared with those of a control group. Method: A Fecal Continence Index Questionnaire (ICF) and a Questionnaire for Assessment of Quality of Life Related to Fecal Continence in Children and Adolescents (QQVCFCA) were administered to 63 patients with ARM, aged from 7 to 19 years, whose surgical treatment had been completed for at least 6 months. The patients were compared to a control group of 59 children. Results: In the control group, 25 (42.4%) patients had good continence and 34 (57.6%), normal continence. We found that the quality of life in children with ARM is compromised globally, in all areas and in the ICF questionnaire, compared to controls (p<0.001). There was no difference between patients with high and low defects. Thirty-two (50.8%) patients had other associated anomalies. Conclusion: In patients operated for ARM correction, quality of life and ICF were compromised, and there was no difference between patients with high-type and low-type of the disease. In about half the cases there are other associated malformations.

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Tethered Cord and Anorectal Malformations: A Case Series

European Journal of Pediatric Surgery ◽

10.1055/s-0037-1606844 ◽

2017 ◽

Vol 28 (06) ◽

pp. 484-490 ◽

Cited By ~ 1

Author(s):

Lorena Canazza ◽

Milena Meroni ◽

Giorgio Selvaggio ◽

Cecilia Parazzini ◽

Laura Valentini ◽

...

Keyword(s):

Demographic Data ◽

Case Series ◽

Tethered Cord ◽

Anorectal Malformations ◽

International Classification Of Functioning ◽

Clean Intermittent Catheterization ◽

Critical Elements ◽

Long Term Follow Up

Introduction The clinical manifestation of a stretched low-lying cone (LLC) is represented by the tethered cord syndrome (TCS) with cutaneous, urologic, neurologic, and orthopaedic dysfunctions. TC is frequently found in patients with anorectal malformations (ARMs). The aim of our article is to report a series of patients affected by LLC and ARMs and evaluate their management and long-term follow-up results. Materials and Methods We performed a retrospective analysis over a period of 15 years including patients with ARM and TC and excluding those with severe polymalformations. We collected information related to the types of malformations and demographic data. We analyzed their management (perinatal protocol, radiological investigations, surgery, and multidisciplinary follow-up). QOL was assessed through the International Classification of Functioning, Disability, and Health for Children and Youth (ICF-CY). Results Thirty-three patients among 210 ARM cases had TC (16%). Eleven of them underwent neurosurgery. One patient had retethering; out of 11 patients, 4 remained stable and 6 improved after surgery (UDS normalization and resolution of symptoms). At a mean follow-up of 10 years, four patients were on clean intermittent catheterization and five on the Peristeen transanal irrigation. The majority of patients were defined as 3 (from 1-bad to 5-excellent) for their physical and mental state. Conclusion The use of MRI is considered to complete the ARM screening in detecting TC. The multidisciplinary approach is crucial and helps in defining the management of patients. In fact, it is not clear how the features of ARM and TC affect each other. The selection of cases for surgery should take into account the critical elements.

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Gynecological and psycho-sexual aspects of women with history of anorectal malformations

Pediatric Surgery International ◽

10.1007/s00383-021-04905-2 ◽

2021 ◽

Author(s):

Noemi Bicelli ◽

Emanuele Trovalusci ◽

Monica Zannol ◽

Piergiorgio Gamba ◽

Gianna Bogana ◽

...

Keyword(s):

Sexual Functioning ◽

Reproductive Tract ◽

Anorectal Malformations ◽

Careful Study ◽

Long Term Follow Up ◽

History Of ◽

Normal Life Span ◽

Female Sexual Functioning

Abstract Purpose Women with anorectal malformation (ARM) are expected to have a normal life span, therefore, gynecological and psycho-sexual issues are also important. Aim of the study was to assess these aspects in adult females with history of ARM. Methods Thirty-seven women from two ARM referral centers, aged ≥ 16, were identified. Gynecologic visit, cervicovaginal swab, pelvic ultrasound, FSH, LH, prolactin, progesterone, 17–β–estradiol, DHEAS, testosterone, TSH during follicular and luteal phases, and administration of FSFI questionnaire to screen the female sexual functioning were performed. Data were compared with six controls. Results Nineteen patients, mean age 21.7 (16–45), participated to the study. Associated anomalies, mostly affecting limbs, vertebrae and genitalia, were present in 57.8% of cases. Mullerian anomalies were retrieved in 36.8%. Hormones’ levels were normal. Concerning sexual functioning, four women (21%) reported dyspareunia or impossible penetration, four did not answer the FSFI questionnaire due to lack of confidence about their sexuality, and three scored lower than the cut-off value for female sexual function. Conclusion This study confirms the importance of a multidisciplinary long-term follow-up for ARM patients, including a careful study of the reproductive tract to detect and treat those conditions that could affect the fertility. Moreover, an appropriate psychological support should be provided.

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Long-Term Follow-Up Results of the Treatment of High and Intermediate Anorectal Malformations Using a Modified Technique of Posterior Sagittal Anorectoplasty

European Journal of Pediatric Surgery ◽

10.1055/s-2001-17155 ◽

2001 ◽

Vol 11 (4) ◽

pp. 242-245 ◽

Cited By ~ 5

Author(s):

N. T. Liem ◽

B. D. Hau

Keyword(s):

Anorectal Malformations ◽

Posterior Sagittal Anorectoplasty ◽

Modified Technique ◽

Long Term Follow Up

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Anorectal malformations ? results of treatment and long-term follow-up in 208 patients

Pediatric Surgery International ◽

10.1007/bf00174882 ◽

1991 ◽

Vol 6 (1) ◽

Cited By ~ 45

Author(s):

R. Rintala ◽

H. Lindahl ◽

I. Louhimo

Keyword(s):

Anorectal Malformations ◽

Results Of Treatment ◽

Long Term Follow Up

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The Role of Laparoscopy in Anorectal Malformations

European Journal of Pediatric Surgery ◽

10.1055/s-0040-1701700 ◽

2020 ◽

Vol 30 (02) ◽

pp. 156-163 ◽

Cited By ~ 2

Author(s):

Rebecca M. Rentea ◽

Devin R. Halleran ◽

Richard J. Wood ◽

Marc A. Levitt

Keyword(s):

Minimally Invasive ◽

Surgical Approach ◽

Perioperative Complications ◽

Anorectal Malformations ◽

Urinary Continence ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Long Term Follow Up

AbstractThe use of laparoscopy in the minimally invasive management of anorectal malformations (ARMs) continues to evolve, although the principles guiding the anatomic surgical repair and clinical follow-up remain unchanged. In this review, we detail the advantages, indications, contraindications, complications, and issues unique to the minimally invasive approach to ARM. A comprehensive search of the PubMed and Embase databases was performed (2014–2018). Full-text screening, data abstraction, and quality appraisal were performed of articles describing the use of laparoscopy in ARM and cloaca. While new developments and approaches to ARM utilizing minimally invasive techniques and timing for surgical approach have been detailed, a unique complication profile involving greater risk of rectal prolapse and retention of a remnant of the original fistula are still consistently reported. Analysis of perioperative complications and long-term functional outcomes, including rates of fecal and urinary continence, are lacking. It is clear that patient selection for the choice of surgical approach based on precise preoperative delineation of the anatomy is the key. Adherence to the principles of ARM repair as well as application of operative/imaging adjuncts will yield the best technically safe minimally invasive approach to ARM. Continued efforts for standardized reporting and long-term follow-up are required.

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Perineal Fistula With High Dilated Colon: One of a Special Type of Anorectal Malformations

10.21203/rs.3.rs-123589/v1 ◽

2020 ◽

Author(s):

Sen Li ◽

Jun Wang

Keyword(s):

Bowel Function ◽

Anorectal Malformations ◽

Posterior Sagittal Anorectoplasty ◽

Function Score ◽

Perineal Fistula ◽

Defecation Function ◽

Definitive Surgery ◽

Inhibitory Reflex

Abstract Background The perineal fistula with high dilated colon is a rare anomalous in the spectrum of anorectal malformations. The aim of this study is to explore the diagnosis and treatment of this special type of perineal fistula (SPF), and to avoid the severe consequence due to misdiagnosis.Methods From March 2012 to January 2019, 7 patients who suffered from perineal fistula with high dilated colon were retrospectively reviewed. Three were operated on primarily by our department, and 4 cases were re-operated after a perineal anoplasty repair performed elsewhere. Four were operated by laparoscopic anorectoplasty (LARP), and 3 cases were repaired by posterior sagittal anorectoplasty (PSARP). The follow-up outcomes were compared with 71 cases of normal perineal fistula (NPF) in the same period.Results 7 cases have been followed up for 0.5-4 years (M=2.57±1.26) after definitive surgery. Their bowel function score (BFS) was lower than normal perineal fistula (SPF=12, rang:5-18; NPF=18.5, rang:18-20). Four cases underwent anorectomanometry. The incidence of rectoanal inhibitory reflex (RAIR) was lower in the special type group. (p=0.14). Three cases of barium enema angiography: 2 cases of colorectal dilatation and thickening changes, 1 case showed no obvious abnormalities.Conclusions Anorectal perineal fistula should be examined by distal colostogram at preoperation. Select appropriate surgical approach is essential for children’s defecation function, and blind surgery can seriously affect long-term defecation function.

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Therapy and prevention for mental health: What if mental diseases are mostly not brain disorders?

Behavioral and Brain Sciences ◽

10.1017/s0140525x1800105x ◽

2019 ◽

Vol 42 ◽

Cited By ~ 2

Author(s):

John P. A. Ioannidis

Keyword(s):

Mental Health ◽

Mental Disease ◽

Brain Disorders ◽

Social Stressors ◽

Labor Education ◽

Mental Diseases ◽

Long Term Follow Up ◽

Political Decisions

AbstractNeurobiology-based interventions for mental diseases and searches for useful biomarkers of treatment response have largely failed. Clinical trials should assess interventions related to environmental and social stressors, with long-term follow-up; social rather than biological endpoints; personalized outcomes; and suitable cluster, adaptive, and n-of-1 designs. Labor, education, financial, and other social/political decisions should be evaluated for their impacts on mental disease.

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