التفاصيل البيبلوغرافية
| العنوان: |
Management of Anorectal Malformations: Our Experience. |
| المؤلفون: |
Wani, M. Y., Wani, N. A., Shafi, Ishfaq |
| المصدر: |
Journal of Indian Association of Pediatric Surgeons; Jul-Sep2007, Vol. 12 Issue 3, p166-167, 2p |
| مصطلحات موضوعية: |
HUMAN abnormalities, ANAL fistula, ANAL surgery, COLOSTOMY, INFANTS, SURGERY, BOWEL & bladder training, THERAPEUTICS |
| مصطلحات جغرافية: |
JAMMU & Kashmir (India), INDIA |
| مستخلص: |
Aim: To study the clinical profile of Anorectal malformations (ARM's) in our Valley of Kashmir and the appropriate surgical management and optimum postoperative rehabilitation of the children affected with ARM's. Methods: This prospective study extended over a period of 5 years and involved a total of 96 patients. Patients were thoroughly evaluated for the nature and type of ARM's and any associated anomalies using appropriate investigations including prone cross table lateral view X-ray, X-ray lumbosacral spine, renal and spinal USG, MCU, IVU, echocardiography, distal high pressure colostogram, cystoscopy/ vaginoscopy. The defect was appropriately classified according to Wingspread Classification. The patients were managed according to the type of the defect. All rectoperineal fistulae, in both sexes, were repaired without a prior colostomy. A protective colostomy was fashioned in all male babies with rectourethral fistula, rectovesical fistula, imperforate anus without fistula and rectal atresia. In female babies, a prior colostomy was performed in all cases of rectovaginal fistula, imperforate anus without fistula, rectal atresia and persistent cloaca. A protective colostomy was also fashioned in all cases of H-type fistula. We always preferred a descending colostomy with separated stomas. Anal dilatations formed a very important part of postoperative management. Bowel training helped achieve the best possible results in patients with good prognosis type of defect. Bowel management was offered to patients who had a poor prognostic type of defect or in whom Bowel Training Programme had failed to achieve continence. Results: Out of a total of 96 patients, 90 were assessed for the results of surgery. Overall, males were affected more commonly than females. High and low anomalies were commoner in males. Intermediate anomalies were more common in females. All the cases of H-type fistula in our series were females. Associated anomalies were present in 48.88% patients. Genitourinary anomalies were the commonest. Bony sacral anomalies were the next most common type of associated anomalies and the only type that significantly altered the functional outcome of ARM's. PSARP was the most common definitive surgery performed. Bowel continence was the main aim of surgical correction and, therefore, was the most important factor to be assessed during follow-up. All cases of low defects were totally continent. None of our cases of rectovaginal fistula and bladder neck fistula was totally continent. Voluntary bowel movements were achieved in 77.77% cases. Soiling was seen in 27.78% patients. The highest incidence of soiling was seen in bladder neck fistula and persistent cloaca. Conclusions: ARM's are frequently occurring birth defects in our State. The incidence and clinical spectrum of these anomalies are similar to those reported from other parts of our country and the rest of the world. The exception to this fact is the H-type fistula that has not been reported very frequently by other authors. In general, the main purpose of surgical management of a baby with ARM is not only to restore the anatomic continuity of alimentary canal but also the physiology of the canal including bowel control (main),urinary control and future sexual function. [ABSTRACT FROM AUTHOR] |
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