Long-term outcome of internal sphincter myectomy in patients with internal anal sphincter achalasia.

Hdl Handle:
http://hdl.handle.net/10147/207415
Title:
Long-term outcome of internal sphincter myectomy in patients with internal anal sphincter achalasia.
Authors:
Doodnath, Reshma; Puri, Prem
Affiliation:
Children's Research Centre, Our Lady's Children's Hospital, Crumlin, Dublin 12,, Ireland.
Citation:
Pediatr Surg Int. 2009 Oct;25(10):869-71.
Journal:
Pediatric surgery international
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207415
DOI:
10.1007/s00383-009-2436-5
PubMed ID:
19680665
Abstract:
BACKGROUND: Internal anal sphincter achalasia (IASA) is a condition with presentation similar to Hirschsprung's disease (HD), but with the presence of ganglion cells on rectal suction biopsy (RSB). The diagnosis is made on anorectal manometry (ARM) by the absence of the rectosphincteric reflex on rectal balloon inflation. Internal sphincter myectomy (ISM) is the treatment of choice for patients with IASA. Recently, botulinum toxin has been used to treat IASA patients. The purpose of this study was to assess the long-term bowel function in patients with IASA following ISM. METHODS: The medical records of 24 patients with IASA managed by ISM during 1993-2005 were examined. There were 18 boys and 6 girls, aged 2-12 years. All patients presented with intractable constipation with or without soiling. The diagnosis was made by the demonstration of the absence of the rectosphincteric reflex on ARM. HD was excluded by the presence of ganglion cells and normal acetylcholinesterase activity in RSB. Patients were followed 4-14 years later. RESULTS: Fifteen (62.5%) patients at the time of follow-up had regular bowel motions without the use of laxatives. Six (25%) patients had regular bowel motions, but remained on small doses of laxatives. Two (8.3%) patients who suffered from constipation and soiling required twice weekly enemas to remain clean. One (4.2%) patient required resection of dilated rectosigmoid colon 3 years after myectomy, remains on laxatives, but has normal bowel control. No patients had faecal incontinence following ISM. CONCLUSION: This long-term follow-up study shows that the vast majority of IASA patients have normal bowel control following ISM.
Language:
eng
MeSH:
Anal Canal/*abnormalities/*surgery; Child; Child, Preschool; Constipation/etiology; Digestive System Abnormalities/complications/*surgery; Digestive System Surgical Procedures/*methods; Female; Follow-Up Studies; Humans; Male; Recovery of Function; Retrospective Studies; Treatment Outcome
ISSN:
1437-9813 (Electronic); 0179-0358 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorDoodnath, Reshmaen_GB
dc.contributor.authorPuri, Premen_GB
dc.date.accessioned2012-02-01T10:24:26Z-
dc.date.available2012-02-01T10:24:26Z-
dc.date.issued2012-02-01T10:24:26Z-
dc.identifier.citationPediatr Surg Int. 2009 Oct;25(10):869-71.en_GB
dc.identifier.issn1437-9813 (Electronic)en_GB
dc.identifier.issn0179-0358 (Linking)en_GB
dc.identifier.pmid19680665en_GB
dc.identifier.doi10.1007/s00383-009-2436-5en_GB
dc.identifier.urihttp://hdl.handle.net/10147/207415-
dc.description.abstractBACKGROUND: Internal anal sphincter achalasia (IASA) is a condition with presentation similar to Hirschsprung's disease (HD), but with the presence of ganglion cells on rectal suction biopsy (RSB). The diagnosis is made on anorectal manometry (ARM) by the absence of the rectosphincteric reflex on rectal balloon inflation. Internal sphincter myectomy (ISM) is the treatment of choice for patients with IASA. Recently, botulinum toxin has been used to treat IASA patients. The purpose of this study was to assess the long-term bowel function in patients with IASA following ISM. METHODS: The medical records of 24 patients with IASA managed by ISM during 1993-2005 were examined. There were 18 boys and 6 girls, aged 2-12 years. All patients presented with intractable constipation with or without soiling. The diagnosis was made by the demonstration of the absence of the rectosphincteric reflex on ARM. HD was excluded by the presence of ganglion cells and normal acetylcholinesterase activity in RSB. Patients were followed 4-14 years later. RESULTS: Fifteen (62.5%) patients at the time of follow-up had regular bowel motions without the use of laxatives. Six (25%) patients had regular bowel motions, but remained on small doses of laxatives. Two (8.3%) patients who suffered from constipation and soiling required twice weekly enemas to remain clean. One (4.2%) patient required resection of dilated rectosigmoid colon 3 years after myectomy, remains on laxatives, but has normal bowel control. No patients had faecal incontinence following ISM. CONCLUSION: This long-term follow-up study shows that the vast majority of IASA patients have normal bowel control following ISM.en_GB
dc.language.isoengen_GB
dc.subject.meshAnal Canal/*abnormalities/*surgeryen_GB
dc.subject.meshChilden_GB
dc.subject.meshChild, Preschoolen_GB
dc.subject.meshConstipation/etiologyen_GB
dc.subject.meshDigestive System Abnormalities/complications/*surgeryen_GB
dc.subject.meshDigestive System Surgical Procedures/*methodsen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshFollow-Up Studiesen_GB
dc.subject.meshHumansen_GB
dc.subject.meshMaleen_GB
dc.subject.meshRecovery of Functionen_GB
dc.subject.meshRetrospective Studiesen_GB
dc.subject.meshTreatment Outcomeen_GB
dc.titleLong-term outcome of internal sphincter myectomy in patients with internal anal sphincter achalasia.en_GB
dc.contributor.departmentChildren's Research Centre, Our Lady's Children's Hospital, Crumlin, Dublin 12,, Ireland.en_GB
dc.identifier.journalPediatric surgery internationalen_GB
dc.description.provinceLeinster-

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