鎖肛術後排便機能障害に対する再手術としての Anterior Sagittal Anorectoplasty

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Since 1985, anterior sagittal anorectoplasty (ASARP) as a re-do operation has been performed in 10 postoperative patients with imperforate anus presenting severe to moderate fecal incontinence. The indication of this operation was defined as the presence of fecal incontinence and an anal orifice shifted anterior to the center of contraction of external sphincter muscle following electrical stimulation. The postoperative assessment of anorectal functions was based on a clinical as well as manometric and radiographical evaluations. The clinical score, based on the scale proposed by the Japanese Study Group of Anorectal Anomaly, showed that the postoperative anal function had improved significantly. The average total score was 6.1 postoperatively, a significant increase from a 3.4 preoperative score. Preoperative and postoperative incontinence scores were 1.9 and 3.4, respectively, and soiling scores were 0.4 and 1.4, respectively. Also, the improvement in the clinical score was progressive after re-do operation. In manometric studies, maximum anal pressure increased significantly from 18.2 ± 5.6 mmHg to 24.0 ± 6.0 mmHg postoperatively. Three patients of six who had a preoperative barium enema study, showed poor or fair anterior angulation, and the leakage of contrast medium from the anus was seen in three of these cases before operation. These radiographic findings were improved in all patients postoperatively.These results suggest that anterior sagittal anorectoplasty is a valuable procedure as a re-do operation for patients with fecal incontinence following a primary operation for congenital anorectal malformations.
日本小児外科学会の論文
1991-08-20

鎖肛術後排便機能障害に対する再手術としての Anterior Sagittal Anorectoplasty

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