Surgical treatment of anorectal malformations

The goal of surgery for anorectal malformations (ARM) is to achieve good bowel, urinary, and sexual functions, as well as the ability for children to become healthy adults. Various surgical procedures and surgical management protocols have been explored or devised by pediatric surgeons. These are de...

Full description

Saved in:
Bibliographic Details
Published in:Surgery today (Tokyo, Japan) Japan), 2013-09, Vol.43 (9), p.955-962
Main Authors: Iwai, Naomi, Fumino, Shigehisa
Format: Article
Language:English
Subjects:
Adult
Anorectal Malformations
Anus, Imperforate - classification
Anus, Imperforate - epidemiology
Anus, Imperforate - genetics
Anus, Imperforate - surgery
Child
Digestive System Surgical Procedures - methods
Fecal Incontinence - prevention & control
Female
Humans
Incidence
Infant, Newborn
Male
Medicine
Medicine & Public Health
Postoperative Complications - prevention & control
Prognosis
Review Article
Sexual Dysfunction, Physiological - prevention & control
Surgery
Surgical Oncology
Treatment Outcome
Urinary Incontinence - prevention & control
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:The goal of surgery for anorectal malformations (ARM) is to achieve good bowel, urinary, and sexual functions, as well as the ability for children to become healthy adults. Various surgical procedures and surgical management protocols have been explored or devised by pediatric surgeons. These are described in this review. Making a correct type classification by invertography, fistelography and urethrography in the neonatal period allows pediatric surgeons to select an appropriate surgical strategy. Surgery for low-type malformations is principally neonatal perineoplasty, while that for intermediate- or high-type malformations is colostomy, followed by a pull-through operation during infancy. Posterior sagittal anorectoplasty or laparoscopy-assisted surgery has recently been accepted as alternative procedures. Fecal incontinence represents a devastating problem that often prevents a patient from becoming socially accepted and may cause serious psychological sequelae. One-third of adult patients with high- or intermediate-type malformations occasionally complain of fecal incontinence after surgery. Most patients with ARM have normal urinary function if they do not have urinary tract or sacral anomalies. These associated anomalies also influence the prognosis for sexual function, especially in males. Some female patients have experienced normal vaginal delivery and had children. In patients with cloacal malformation, however, fertility or sexual problems are also often present. Based on this information, it is clear that only well-planned and systemic treatments can provide a good functional prognosis after making a correct classification in the neonatal period.
ISSN:0941-1291
1436-2813
DOI:10.1007/s00595-012-0435-y