dc.contributor.author | Kigo, Charles N | |
dc.date.accessioned | 2013-05-23T08:56:45Z | |
dc.date.available | 2013-05-23T08:56:45Z | |
dc.date.issued | 2001 | |
dc.identifier.citation | Master of Medicine in Surgery, University of Nairobi, 2001 | en |
dc.identifier.uri | http://erepository.uonbi.ac.ke:8080/xmlui/handle/11295/24729 | |
dc.description.abstract | Posterior sagittal repair was used to repair 352 patients with anorectal malformations·
between 1st January 1990 and 31st December 1999. We evaluated 193 patients who were
over 3 years of age and with an adaptation period of 6 months after the colostomy closure
for bowel control.
Males were 80 (41.5%) and females were 113 (58.5%), low anomalies were 86.5% and
high anomalies were 13.5%, and while sacral defects were present in 14.0%. Colostomy
was fashioned in 92.2% of the patients before definitive surgery, while only 7.8% were
managed without a colostomy. More than half of the patients had their colostomies
fashioned before the age of one month. Majority of males (97.1 %) had colostomy
fashioned before the age of one month, while 66.7% of females had their colostomy
fashioned after the age of one month. The overall mortality was 1.0%.
The type of colostomies fashioned was divided sigmoid in 75.8% and transverse loop
colostomy in 24.2% of the patients. Approximately 17.0% of these colostomies were
revised. Transverse loop colostomy was revised in 58.1%of the patients compared to only
3.7% in divided sigmoid colostomy. Majority of the patients (90.5% of the patients) had
to wait longer than 6 months for definitive surgery after colostomy fashioning.
Majority of the patients in this series had PSARP in 76.7%of the patients, while 17.6%
and 3.1% had anoplasty and a combined PSARP and abdominal approach respectively.
By the age 5 years 93.3% of the patients have had definitive surgery while only 10.9% by
age of6 months. Only 5.6% wait for less than 6 months colostomy closure after
definitive surgery.
Overall voluntary bowel movement (VBM) is achieved in 71.5% of the patients. Patients
who had colostomy fashioned before the age of one month achieve VBM in 79.1% of the
patients while those fashioned after one year in 61.1 %. Overall females achieve VBM in
77.0% of the patients compared to 63.8% in males. Patients with perineal fistula achieve
VBM in 79.1% in males and 75.0% in females, 76.0% in rectovestibular fistula, 73.9% in
rectourethralfistula, 56.0% in anorectal malformations without a fistula, 25.0% in
vaginalfistula and 12.5% in rectovesical fistula.
Overall where anoplasty was the definitive surgery VBM was achieved in 82.4% of the
patients and 74.3% in PSARP of the patients. The patients who had definitive surgery
before the age of 6 months achieved VBM in 81.1% compared to 61.5% when done after
5years.Overall patients with sacral defects achieve VBM in 25.9% compared to 78.9% in
the patients with normal sacrum. The patients with low anomalies achieved VBM in
75.4%compared to 46.1% in high anomalies.
Soiling was present in 21.2% of the patients. Patients with high anomalies and sacral
defects e.g. rectovesical fistula and rectovaginal fistula have high incidence of soiling.
Constipation is present in 7.3% of the patients and low (simple) anomalies have the
highest incidence.
In this series 24 (12.4%) of the 193 patients underwent secondary operations. Patients
who had one redo operation were 21(87.5%) while 3(12.5%) of the patients had more
than one redo operations. Indications for reoperations were severe fecal incontinence and
severe constipation among others. All patients for redo operations due to severe
constipation had normal sacrum. The patients with normal sacrum and low anomalies
required one redo operation while some of the patients with high anomalies and sacral
defects had more than one redo operations.
All the patients who had one reoperation had good to fair results while all the patients
who had more than one redo operations had fair to poor bowel control results. All
patients with severe constipation had normal sacrum and had significant improvement
after one redo operation. Sacral defects in the patients with severe fecal incontinence
were present in 91.7% of the patients. Where severe fecal incontinence was the
indication for redo operation, significant improvement was in 50.0% of the patients while
33.3% and 16.7% of the patients had fair and poor results respectively. | en |
dc.language.iso | en | en |
dc.publisher | University of Nairobi | en |
dc.title | Bowel Function Following Posterior Saggital Repair Of Anorectal Malformations (a Ten-year Retrospective Study) | en |
dc.type | Thesis | en |
dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |
local.publisher | Faculty of Medicine | en |