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Eur J Pediatr Surg 2019; 29(03): 276-281
DOI: 10.1055/s-0038-1641599
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Long-Term Outcome after Dynamic Graciloplasty for Treatment of Persistent Fecal Incontinence in Patients with Anorectal Malformations

Johan Danielson
1   Barnkirurgiska Kliniken, Uppsala Universitet Institutionen for Kvinnors Och Barns Halsa, Uppsala, Sweden
,
Urban Karlbom
2   Department of Surgery, Uppsala Universitet Institutionen for Kirurgiska Vetenskaper, Uppsala, Sweden
,
Tomas Wester
3   Department of Pediatric Surgery, Astrid Lindgren Children's Hospital, Stockholm, Sweden
,
Wilhelm Graf
2   Department of Surgery, Uppsala Universitet Institutionen for Kirurgiska Vetenskaper, Uppsala, Sweden
› Author Affiliations
Further Information

Publication History

13 April 2017

26 February 2018

Publication Date:
13 April 2018 (online)

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Abstract

Purpose Dynamic graciloplasty (DGP) has been used to treat severe fecal incontinence since the 1980s. Previous studies have shown an inferior outcome in patients with anorectal malformations (ARMs). Our experience has been that DGP has been appreciated by ARM -patients. The objective of the study was to evaluate the long-term outcome of DGP in our patients with ARM compared with patients with other underlying conditions.

Materials and Methods Twenty-three patients operated with DGP at our institution from 1996 to 2010 were sent validated bowel function and quality of life questionnaires. Eighteen of 23 responded. Seven had ARM and 11 had other etiologies of fecal incontinence. The mean follow-up time was 11.6 years (range, 5–17).

Results Four of 7 of the patients with ARM and 8 of 11 of patients with other etiologies used their implants at follow-up. The Miller incontinence score was slightly higher for patients with ARMs, but they had less constipation and higher Fecal Incontinence Quality of Life (FIQL)- and 36-Item Short Form Health Survey (SF-36) scores. None of the differences were statistically significant.

Conclusion This study cannot confirm earlier reports in which DGP has an inferior outcome in patients with ARM. We therefore believe that the procedure should remain a treatment option for selected patients.

Keywords

anorectal malformation - fecal incontinence - dynamic graciloplasty - long-term outcome
 

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