1994 Volume 30 Issue 5 Pages 878-885
Eleven cases of post-operative anorectal malformation with fecal incontinence were admitted to our institute. (9 cases: the intermediate or high type of anomaly, 2 cases: the low type of anomaly) The clinical assessment of anorectal function (full mark: 8 points) was performed on all patients. Ten cases showed 0-2 points and one case showed 4 points. The treatment protocol of fecal incontinence consists of the es tablis hment of habitual evacuatuin, the control of fecal condition to decrease frequency of incontinence or soiling, training of voluntary sphincteric contraction by bouginage, mental support by the family and revision of the operable anatomical abnormalities. The detected causes of the poor anorectal function were as follows. The abnormal distribution of sphincteric complex was found in 5 cases, abnormal distribution of puborectal muscle and sphincter complex in 3, cystic dilatation of the remained part of urethral fistula in 1, rectourethral fistula in 2, severe rectoanal stenosis after posterior sagittal anorectoplasty (PSARP) in 1, vesico-vaginal fistula in 1 and severe sacral anomaly in 2 cases. The surgical corrections were completed in 10 cases except for one low type anomaly with severe sacral deformity. An anal transplant was done in 3 cases, PSARP in 5, an division of the recto-urethral fistula through a sacroperineal approach in 1, and colostomy and bouginage of anorectum in 1 case. Seven cases showed marked improvement in the clinical assessment over 5 points. Four cases did not make any improvement and two cases with severe sacral anomaly learned rectal lavage at home.
