Functional Outcomes of Patients Who Underwent Anorectal Malformation Repair Using MRI Guidance.

Autor: Dougherty D; University of Michigan, Michigan Medicine, Department of Surgery, Section of Pediatric Surgery, C.S. Mott Children's Hospital, 1540 E. Hospital Dr., Ann Arbor, MI 48109-4211, United States; Connecticut Children's Hospital, Department of Surgery, Section of Pediatric Surgery, 282 Washington Street, Hartford, CT 06106, United States., Ralls MW; University of Michigan, Michigan Medicine, Department of Surgery, Section of Pediatric Surgery, C.S. Mott Children's Hospital, 1540 E. Hospital Dr., Ann Arbor, MI 48109-4211, United States; Nationwide Children's Hospital - Toledo, Department of Surgery, Section of Pediatric Surgery, Mercy Health - St. Vincent Medical Center, 2222 Cherry St., Suite 1800, Toledo, OH 43608, United States., Plagens CJ; University of Michigan, Michigan Medicine, Department of Surgery, Section of Pediatric Surgery, C.S. Mott Children's Hospital, 1540 E. Hospital Dr., Ann Arbor, MI 48109-4211, United States., Ladino-Torres M; University of Michigan, Michigan Medicine, Department of Radiology, C.S. Mott Children's Hospital, 1540 E. Hospital Dr., Ann Arbor, MI 48109-4211, United States., Williams KM; University of Michigan, Michigan Medicine, Department of Surgery, Section of Pediatric Surgery, C.S. Mott Children's Hospital, 1540 E. Hospital Dr., Ann Arbor, MI 48109-4211, United States., Wild L; University of Michigan, Michigan Medicine, Department of Surgery, Section of Pediatric Surgery, C.S. Mott Children's Hospital, 1540 E. Hospital Dr., Ann Arbor, MI 48109-4211, United States., Jarboe MD; University of Michigan, Michigan Medicine, Department of Surgery, Section of Pediatric Surgery, C.S. Mott Children's Hospital, 1540 E. Hospital Dr., Ann Arbor, MI 48109-4211, United States; Nationwide Children's Hospital - Toledo, Department of Surgery, Section of Pediatric Surgery, Mercy Health - St. Vincent Medical Center, 2222 Cherry St., Suite 1800, Toledo, OH 43608, United States. Electronic address: marcus.jarboe@nationwidechildrens.org.
Jazyk: angličtina
Zdroj: Journal of pediatric surgery [J Pediatr Surg] 2024 Jun; Vol. 59 (6), pp. 1044-1049. Date of Electronic Publication: 2024 Jan 01.
DOI: 10.1016/j.jpedsurg.2023.12.023
Abstrakt: Background: Despite the initiation of minimally invasive laparoscopic techniques, the majority of patients who undergo anorectal malformation repair still experience functional bowel issues in childhood, including constipation and fecal incontinence. In this study, we evaluate the functional outcomes of a procedure in which magnetic resonance imaging guidance is used during initial laparoscopic repair to better locate the epicenter of the sphincter muscle complex and pelvic floor with the goal of more accurate placement of the neoanus and improved functional outcomes.
Methods: A retrospective chart review evaluated demographic, operative, and outcome details for patients who underwent this procedure. A telephone survey was employed to determine levels of social continence using the validated Baylor Continence Scale and to determine what type of bowel management is used.
Results: Twenty-six patients were included. Median age at operation was 7 months, and median age at follow-up was 4 years old, with a range of 1-9. Bowel management regimen results revealed that 19 % (n = 5) use no bowel management regimen, 58 % (n = 15) use laxatives only, and 23 % (n = 6) use enemas. Enema use was not associated with different spine or sacral anomalies (p = 0.77). Fifteen patients (58 %) answered the Baylor Continence Scale questions and had a median score of 14. No difference was found in scores when accounting for lesion level (p = 0.43), quality of needle placement (p = 0.46), or quality of sphincter muscles (p = 0.75).
Conclusions: Using MRI guidance in the repair of anorectal malformations shows promise in both the qualitative and quantitative functional outcomes of this complex patient population.
Level of Evidence: Level III.
Competing Interests: Conflicts of interest None.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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