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

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    Authors
    Doodnath, Reshma
    Puri, Prem
    Affiliation
    Children's Research Centre, Our Lady's Children's Hospital, Crumlin, Dublin 12,, Ireland.
    Issue Date
    2012-02-01T10:24:26Z
    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
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    Citation
    Pediatr Surg Int. 2009 Oct;25(10):869-71.
    Journal
    Pediatric surgery international
    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
    ISSN
    1437-9813 (Electronic)
    0179-0358 (Linking)
    ae974a485f413a2113503eed53cd6c53
    10.1007/s00383-009-2436-5
    Scopus Count
    Collections
    Our Lady's Children's Hospital Crumlin

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