Evaluation of continence and life quality of patients who were operated due to anorectal malformation

Purpose: Anorectal malformations are a group of diseases which are difficult to follow and treat. Therefore, the patients who were operated experience problems such as incontinence, constipation and soiling after surgery, which affect their life quality. The purpose of this study was to investigate the postoperative problems of patients who were operated in our clinic due to ARM and to reveal the factors affecting these problems. Material and method: The patient files of 110 children who had been operated due to ARM between January 2007 and December 2017 were analysed retrospectively. Of the patients who were included in the study, prenatal pathology, the presence of consanguineous marriage, age, gender, radiological findings, complaints at the time of admission, time of the first response, types of the first response, comorbid anomalies, examination findings under general anaesthesia, surgical techniques, types of colostomy, the location of fistula, early and late period complications, indication of redo operation, types of operation, Holschneider, Kelly and Temploton scoring results were recorded. The relationship between the location of fistula, type of operation, comorbid anomaly and scoring values of continence of the patients who had been operated was investigated. The statistical analysis of the data was done by IBM SPSS Statistics Version 20.0 package program. Findings: 22 of the patients were high type, 44 of them were medium type, and 32 of them were low type patients. 6 of the patients had cloacal anomaly. Six patients came after having been operated in an external centre. The complaints of the patients were considered and it was seen that the most common complaint was the absence of the anus in 63 (57.3%) of the patients. The diagnosis of the patients was generally made by physical examination. USG, ECHO, VCUG and different radiographs were taken to investigate additional system pathologies and comorbid anomalies. Additional anomaly was seen in the urogenital system (43.6%) most. Cardiac anomaly (33.6%) was the second most common. Colostomy was performed most frequently as the first response to the patients. In 75 (68.2%) patients, the colostomy was done from the descending part of the colon and it was divergent. PSARP was the most commonly used method in definitive surgery and redo surgery (88/16). Early and late postoperative complications were not experienced in most of the patients. Among the types of first responses (opening colostomy, dilatation, anoplasty, PSARP), a significant difference in terms of mean scores of Kelly, Templeton and Holschenider was found between the patients who had neurosurgical intervention and the patients who did not, between the patients with and without pathology in the urinary system, between types of definitive surgery, between the patients who took dual antibiotics and the patients who took triplet antibiotics after definitive surgery. No significant difference was between Kelly, Templeton and Holschneider scores, which are used in the continence evaluation, in terms of many other parameters. No information about the scoring of 13 (11.8%) patients could be reached in the query. In our study, the overall mean scores of the patients were high. The mean score for the Holschneider was 10.56±3.72, the median was 13 (2-14). The mean for the Kelly score was 3.97±1.97 and the median was 5 (0-6). The mean for the Templeton score was 3.73±1.60 and the median was 4.5 (0.5-4.5). Conclusion: It was concluded in our study that incontinence were observed in an average of 15.5% of the patients, and these patients also had moderate and high type of ARM, Down syndrome, MMR and comorbid coccyx and sacral anomalies. Although it is not included in patient management guidelines, we recommend the use of stimulator examination for the patient follow-up, the need of reoperation and postoperative prognosis evaluation as it is suitable to be used in all age groups. The examinations which are performed by an electrical stimulator are also prognostic and advantageous in mentally retarded patients who are in the incompatible age groups. As constipation that causes overflow incontinence may be high in low-type atresia, patients should be followed up closely for constipation after surgery. Key words: Anorectal malformations, Kelly, Holschneider, Templeton score