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ORIGINAL ARTICLE
Year : 2012  |  Volume : 2  |  Issue : 2  |  Page : 70-73

Bulking agent injection for fecal incontinence in patients with anorectal malformation


Department of Pediatric Surgery, Sick Hospital Children of Bandar Abbas, Hormozgan and Shiraz University of Medical Sciences, Iran

Correspondence Address:
Seyed M. V. Hosseini
Department of Pediatric Surgery, Sick Hospital Children of Bandar Abbas
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-9596.110020

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Background: Patients with anorectal malformation (ARM) frequently suffer from fecal incontinence after surgery because they do not have many of the normal mechanisms of continence. The objectibe of this study was to determine the effects of bulking agent for improving the continence in patients with ARM by correcting the high pressure zone during the toilet training process. Materials and Methods: From December 2008 to June 2011, 16 cases of mid to high ARM that had posterior sagital anorectoplasty were studied prospectively after perianal injection of a bulking agent (Vantris, Promedon/Argentina) into the submucosal layer in high pressure zone of the anal canal about 5 mm from the dentate line, before the start of toilet training. All patients were followed 3 months and 6 months later by manometery, modified defecation pattern scoring and physical examination for complications. They received metronidazole (10 mg/kg/q8h) for 7 days. Result: Eleven male (68.75) and five female (31.25%) included; age range from 1 year to 2 years (mean 3 ± 1.96); Six patients (37.5%) had high type ARM and the remaining were mid type ARM. Internal sphincter pressure ranged from 19.6 ± 6.7 mmHg before intervention to 27.5 ± 6.5 mmHg, after injection until 28.4 ± 8.3 mmHg 6-months after injection ( P < 0.0001). Defecation pattern score on this study changed from 7.4 ± 1.9 to 6.1 ± 1.4, 6 month after study ( P = 0.002). Conclusion: The bulking agent injection could be a cornerstone of post-operative management in patients with ARM.


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