119

Vol. 8. No.2, December 2002

Pena Operation as a Redo Procedure for Anorectal Malformation

Jong-Won Lee, M.D., Hyun-Young Kim, M.D., Seung-Eun Choi, M.D.,

Seung-Eun Jung, M.D., Seong-Cheol Lee, M.D., Kwi-Won Park, M.D.,

Woo-Ki Kim, M.D.

Department of Pediatric Surgery, Seoul National University Children's Hospital,

Department of Surgery, College of Medicine, Seoul National University

Seoul, Korea

The aim of this study was to evaluate the posterior sagittal anorectoplasty (PSARP) as a

re-do operation in patients who failed initial repair of anorectal malformation, Nine patients (4 boys and 5 girls) who had previous failed surgery for anorectal malformation underwent secondary operations through posterior sagittal approach, The main reasons of surgery were

constipation (n=3) and persistent anatomical derangement in spite of previous correction surgery (n=6). In addition to constipation, the former group (n=3) had various anatomical defects, and the latter group (n=6), of course, had constipation in some degrees. Patients

ranged in age from 2 to 19 years (median 3 years) with only one over the age of 6 years. The primary procedures included PSARP (n = 8) and anoplasty (n = O. The rectum was mobilized from surrounding structures through posterior sagittal approach and anatomical defects

were corrected. The rectum underwent reconstruction, which involved relocation of the rectum and anus within the limits of the intact muscle complex. Patients underwent follow-up for periods ranging from 6 to 77 months (mean 37 months) after surgery.

Anatomical corrections of all the defects were successfully fulfilled in 9 patients. All the patients were satisfied with the functional results after redo-PSARP compared with the preoperative defecatory function. This study suggests that (0 some of the patients with

troublesome constipation may have anatomical defects, prominent or hidden, (2) surgeons

should suspect the possibility of anatomical defect as the cause of incontinence and (3) preoperative thorough investigation to reveal the anatomical defects should be included in estimating patients with severe incontinence after previous surgery and planning the correction for failed previous surgery as well. (J Kor Assoc Pediatr Surg 8(2):119-125), 2002,

Index Words: Anorectal malformation, Anatomiml dt~fect, Constipation, Redo-Pena operation

Correspondence : Woo-Ki Kim, Department of Pediatric Surgery,

Seoul National University Children's Hospital, 28 Yeongun-dong,

Chongno-gu, Seoul, 110-744 Korea. Tel; 02) 760-3634,

Fax; 02) 766-3975, E-mail; kimwooki@plaza.snu,ac.kr

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Fig. 1. Anteriorly displaced anus and perianal scarring caused by inflammations before Redo-operation in case 9.

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Table 1. Pre Redo-Pena Operation Status of 9 Patients

Case Age'(m)/Sex Type of ARM 1st Op. name Main cause of redo

65/M RUF PSARP Remnant fistula

2 25/F RVeF PSARP Remnant fistula

3 35/F Cloaca PSARp t Remnant fistula

4 22/F Curarino syndrome PSARP Postop fistula

(Anorectal Stenosis)

5 301M No fistula PSARP Anorectal stricture

6 31/F RVaF PSARP Anorectal abscess

7 311M RVsF PSARP Consitipation

8 47/M No fistula PSARP Consitipation

9 19yr/F RVeF Anoplasty Consitipation

Pre redo-Pena operation W/U

L- Rectourthral fistula(+)

C- Remnant Fistula( +)

C- Rectovaginal Fistula( +)

L- No definite Fistulan on image

L- Ntenotic anus

M- Thinning of rt puborectalis

L- Mild anorcetal stenosis

C- Megarectosigmoid,

Poor anorectal angle

p- Anterior displacement of anus

M- Megarectum,

Thinning of puborectalis muscle

Status before redo

Colostomy

No diversion

Ileostmy

Colostomy

Fistulectomy & Anoplasty

Colostomy

Colostomy

Conservative 'I

Conservative "1

p- Anterior displacement of anus Conservative "1

Mild stenotic anus

Interval-(m)

16

22

7

10

15

21

21

42

19yr

Abbreviations ARM; anorectal malformation, RUF; rectourethral fistula, RVeF; rectovestibular fistula, RVaF; rectovaginal fistula, RVsF; rectovesical fistula, PSARP; posterior sagittal anorectoplasty, W/U; work up, L; loopogram, C; colon study, P; physical examination, M; MRI

• Age(m) at Redo-Pena operation t; Abdominal approach in addition to Pena operation

+ ; Interval(m) between previous 1st correction operation and redo-Pena operation ~ ; Regular enema (2-3/wk) or medication of the laxatives

.£ o'~N :~

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