Anal Canal Plastic Operation for Postoperative Fecal Incontinence After Anorectoplasty for High Anorectal Malformations

Abstract

The puborectalis muscle and anal sphincters are essential for maintaining fecal continence; however, they are underdeveloped in cases of high anorectal malformations (ARMs), posing a risk of long-term postoperative fecal incontinence. We report the application of an anal canal plastic procedure, initially developed for elderly patients with idiopathic fecal incontinence and later applied to patients with chronic fecal incontinence after surgery for Hirschsprung disease, to patients suffering from intractable long-term fecal incontinence following anorectoplasty for high ARMs. The study included three patients (one male and two females) diagnosed as having high ARMs (imperforate anus, rectoprostatic fistula, and persistent cloaca). The patients’ ages at the time of the anal canal plastic procedure ranged from 11 to 24 years. Preoperative bowel function scores, based on the Japanese Study Group of Anorectal Anomaly (JSGAA) scoring system, ranged from 0 to 1. Preoperative imaging revealed anal canal dilation in all patients, with an inability to hold the contrast material. After the anal canal plastic surgery, bowel function scores improved to 5–7, and postoperative imaging showed no anal canal dilation, with the successful holding of the contrast material in all patients. Our results indicate that this procedure is also effective in managing fecal incontinence after anorectoplasty for high ARMs.