Emilio Fernandez-Portilla1, Leticia Moreno-Acosta2, Alfredo Dominguez-Muñoz2, Vicente Gonzalez-Carranza3, Fernando Chico-Ponce de Leon3, Roberto Davila-Perez2. 1. Colorectal Clinic, Hospital Infantil de Mexico Federico Gomez, Calle Doctor Márquez 162, Col Doctores, Del Cuauhtémoc, 06720, Mexico City, Mexico. drejfernandez@gmail.com. 2. Colorectal Clinic, Hospital Infantil de Mexico Federico Gomez, Calle Doctor Márquez 162, Col Doctores, Del Cuauhtémoc, 06720, Mexico City, Mexico. 3. Pediatric Neurosurgery Department, Hospital Infantil de Mexico Federico Gomez, Mexico City, Mexico.
Abstract
PURPOSE: Tethered cord (TC) occurs in 36% of patients with anorectal malformations (ARMs), for whom the benefit of detethering surgery remains unclear regarding bowel and/or bladder function. This study aimed to examine whether cord detethering could improve fecal and urinary incontinence in these patients. METHODS: This was a retrospective study of TC patients (>3 years old) with fecal incontinence and ARMs, who underwent detethering surgery between 2016 and 2020 and were followed up for at least 6 months. RESULTS: Of the 27 included patients, 55% had sacral ratios between 0.4 and 0.7, and in 37% it was < 0.4; the remaining 8% was over 0.7; 52% suffered from colonic hypermotility. After detethering surgery, partial fecal continence was achieved in five patients (18%); total fecal continence, in ten patients (37%); 12 (44%) remained fecally incontinent. Partial urinary continence was obtained in four cases (14%), and the number of patients with total urinary continence rose from 7 (25%) to 15 (55%). Lower extremity symptoms were also improved in 72% of the cases. Patients with colonic hypomotility were found to have a better functional outcome than those with colonic hypermotility (69% vs. 43%, respectively). CONCLUSION: Our study demonstrated that detethering surgery led to remarkably improved bowel and bladder control in ARM patients with fecal incontinence, which, surprisingly, was not associated with sacral ratio.
PURPOSE: Tethered cord (TC) occurs in 36% of patients with anorectal malformations (ARMs), for whom the benefit of detethering surgery remains unclear regarding bowel and/or bladder function. This study aimed to examine whether cord detethering could improve fecal and urinary incontinence in these patients. METHODS: This was a retrospective study of TC patients (>3 years old) with fecal incontinence and ARMs, who underwent detethering surgery between 2016 and 2020 and were followed up for at least 6 months. RESULTS: Of the 27 included patients, 55% had sacral ratios between 0.4 and 0.7, and in 37% it was < 0.4; the remaining 8% was over 0.7; 52% suffered from colonic hypermotility. After detethering surgery, partial fecal continence was achieved in five patients (18%); total fecal continence, in ten patients (37%); 12 (44%) remained fecally incontinent. Partial urinary continence was obtained in four cases (14%), and the number of patients with total urinary continence rose from 7 (25%) to 15 (55%). Lower extremity symptoms were also improved in 72% of the cases. Patients with colonic hypomotility were found to have a better functional outcome than those with colonic hypermotility (69% vs. 43%, respectively). CONCLUSION: Our study demonstrated that detethering surgery led to remarkably improved bowel and bladder control in ARM patients with fecal incontinence, which, surprisingly, was not associated with sacral ratio.
Authors: Desiree van den Hondel; Cornelius Sloots; T H Rob de Jong; Maarten Lequin; Rene Wijnen Journal: Eur J Pediatr Surg Date: 2015-09-21 Impact factor: 2.191
Authors: Giorgia Totonelli; Raffaella Messina; Francesco Morini; Giovanni Mosiello; Paolo Palma; Marianna Scuglia; Barbara D Iacobelli; Pietro Bagolan Journal: Pediatr Surg Int Date: 2017-06-10 Impact factor: 1.827