Clinical assessment of fecal incontinence in patients with anorectal malformation surgery

• Published in: Cirugía pediátrica Vol. 28; no. 1; pp. 15 - 20
• Main Authors: Estors Sastre, B, Bragagnini Rodríguez, P, Fernández Atúan, R, González Martínez-Pardo, N, Elías Pollina, J
• Format: Journal Article
• Language: Spanish
• Published: Spain 13-01-2015
• Subjects: Fecal incontinence; Constipation; Anorectal malformation
• ISSN: 0214-1221

To review our management of anorectal malformations (ARM) and to compare two quantitative scales for clinical assessment of fecal incontinence.
We reviewed all patients with ARM surgery who are currently 3 to 15 years old. Several variables were collected and fecal incontinence was evaluated using two scales: the Holschneider scale and one used previously in our Service, both were filled out through clinical interview.
48 patients were studied, 29 males and 19 females. According to the Peña's classification, 81% had good prognosis indicators (group A) and 19% had bad prognosis indicators (group B). Posterior sagittal anorectoplasty (PSARP) was performed in 32 patients, PSARP and abdominal approach in 3, abdomino-perineal pullthrough in 2, and a "Cut-back" anoplasty in 14 patients. There were not statistical significative differences in average age of continence between both groups. We found no significative differences on the average score of fecal incontinence between both groups using our scale (17.57/20 in group A vs 14/20 in group B; p= 0.05) but it was significantly lower in group B using the Holschneider scale (12.39/14 in group A vs 10.43/14; p= 0.04). Constipation was detected in 16 patients, half of whom had overflow pseudoincontinence.
Our scale penalizes constipation, for this reason the average score of group A was lower and we didn't find differences with respect to group B, contrary to what it happened using Holschneider's scale, so we believe our scale could be more precise to evaluate fecal incontinence of these patients.