Functional disturbances in children after ano-rectal surgery

Abstract

Objective: To determine the prevalence, clinical presentation, highlight management methods and outcome of treatment modalities in children who presented at the University of Calabar Teaching Hospital, Calabar with complications from previous ano-rectal operations. Design: Prospective study of ano-rectal complications from previous ano-rectal surgery in children over a seven year period. Setting: University of Calabar Teaching Hospital, Calabar, a referral and teaching hospital. Subjects: All cases of complications from previous ano-rectal surgery in children that presented at the paediatric surgical clinic of the University of Calabar Teaching Hospital (UCTH), Calabar, between January 1994 and December 2000. Intervention: Conservative measures were commenced in all cases and involved diet manipulation, enema and physiotherapeutic training. Results: The age of maximum presentation was within the 6-10 year age bracket. The main presenting complain was faecal soilage and poor bowel habit. The children notably presented late and was as a result of societal embarrassment at school. Before then the child was within the home environment hence parents may not bother. Complications from anal agenesis operation accounted for the majority of patients 45(54%) while aganglionic megacolon accounted for 39 patients (46%). Treatment in all cases started conservatively with diet manipulation, cleansing enema and physiotherapeutic training. However, with non improvement in faecal soilage, a simple repair involving a narrowing at the ano-rectal junction was carried out. In a follow-up period of between 6-12 months, 45 children had satisfactory clinical status while in 27 children their general conditions had improved. Conclusion: Perseverance and tolerance from the surgeon, the parents and the patient-child is required in these conditions. The late presentation may have helped as the fibres of the external sphincter muscles perhaps have further developed. At this period the child is also psychologically aware of his problem.