Treament of Fecal Incontinence due to Rectal Mislocation in Eleven Pediatric Patients with Imperforate Anus after Anorectoplasty

Fecal incontinence after repair of imperfoate anus is one of the major complications of the anorectoplasty surgery in children. Mental and emotinal distress of fecal incontinence can be problematic and therefore appropriate surgical management is essential. Rectal mislocation is a common cause of fecal incotinence after anorctoplasty in patients with imperfoate anus. Complete mislocation of the rectum is a term used when the rectum is totally displaced from the anal sphincter and partial mislocation is refered mostly to the partial defect of the anal sphincter. Surgical treatment of complete and partial mislocation of the anorectum may lead to fecal continence. The aim of this research was to evaluate the cause of the fecal incontinency and the therapeutic outcome of it in patients operated for imperforate anus and mislocation of the anorectum after anorectoplasey. The study was of descriptive and retrospective type. Eleven patients(7 boys, 4 girls) with mean age of 4.5 years who had fecal incontinence after anorectoplasty were evaluated. The diagnosis of fecal incontinence was based on EMG, MRI, and endoanal sonograply. The author used muscle stimulator under general anesthesia as a final assessment for drawing sphincter mapping to identify the location ofthe defect of anal sphincter. Two patients had complete mislocotion and 9 had partial mislocation of the sphincter muscle. Four patients had surgical repair without colostomy and 7 underwent repair together with colostomy. In 2 patients with complete mislocation, fecal incontinence was treated with anorectum relocation. Nine patients who had sphincter muscle defect (partial mislocation) underwent sphincter repair. Out of 11 patients, nine had adequate control of their bowel movenment (were continent). Meanwhile two patients (6 and 11 years old) had occasional(2 to 3 times/week)involuntary gas passing (for 8 and 48 months after operation, respectively) which was treated medically with Dimethicone. Biofeedback therapy was also taught to enhance anal-sphincter muscle function. All patients had goodsocial inteaction and and their behavior showed a high level of self confidence. Most of sphincter defects occur at 6 and 12 oclock in lithotomy position. So pediatric surgeons have to operate carefully an anal sphincter repair during anorectoplasty procedure.