A Study of Children with Intermediate Anorectal Malformation who have undergone Sacroperineal pull-through with regard to Bowel Function, Quality of Life and Parental Stress.

Abstract

Anorectal malformations comprise a wide spectrum of diseases that affect boys and girls and can involve malformations of the distal anus and rectum, as well as the urinary and genital tracts. Malformations range from minor, easily treated defects that carry an excellent functional prognosis, to complex defects that are difficult to treat, are often associated with other anomalies, and carry a poor functional prognosis. 166 children who had sacroperineal pull-through done for intermediate anorectal malformation from 1996 to 2005 were called for the study. The follow up period ranged 14 to 144 months with a mean follow up period of 6.5 years. The aim of the study was to study the relationship of the pulled through bowel with the anorectal sphincter complex in children who have undergone sacroperineal pull through operation for anorectal malformations (ARM), in order to determine whether the pulled through bowel is correctly sited within the sphincter complex and correlate this with the bowel function. The functional outcome after surgery especially in regard to Quality of Life (QOL), the psychosocial effects on the children due to the anomaly and the treatment were evaluated. The parental stress in bringing up a child with anorectal anomaly was also evaluated. Ages ranged from 2.5 years to 13 years with a mean age of 7.5 years. The parents were young especially the mother with an average age of 23 years. 57% of the family belonged to a low socioeconomic group. 42.8% of the children were first born. 78% and 89% of the children were 2 below 50th percentile for their height and weight respectively. 28% had anal stenosis and 21% had major anal mucosal prolapse. 31% underwent secondary anal procedures. Voluntary bowel movement was seen in 83%, constipation, as detected by the abdominal x-ray, was seen in 100% and soiling in 88%. Anal manometery was done in 18 children. The average anal resting pressure and voluntary squeeze pressures were 52.5 and 144.2 cm of H2O. Magnetic resonance imaging was done in 13 children. The pulled through bowel was central in 77% and the anorectal angle was clear in 92% of the children. 74% of the parents were emotionally affected by the birth of a baby with anorectal malformation. 52% families had difficulty in socializing and 48% children had difficulty in making friends. There was a statistically significant co-relation between soiling and satisfaction with the final result. The quality of life (QOL) scores were on average 7.8 in children with poor continence and children with good continence had a score of 10.5. There was statistically significant improvement in the (QOL) after bowel management program. CONCLUSION : The main post operative complication was constipation leading to fecal impaction and soiling. Management of constipation by bowel management program improves the QOL. Sacroperineal pull-through ensures proper placement of the bowel within the sphincter complex