Murong Wang, Meng Wang, Siqi Li, Long Li
Surgical correction of residual anatomical defects was associated with partial improvement in bowel function in selected children with fecal incontinence after ARM repair, but normal continence was uncommon. Malone appendicostomy or structured bowel management may be preferable in patients with poor sphincteric or neuromuscular reserve.
PURPOSE: To evaluate surgical outcomes in children undergoing secondary procedures for fecal incontinence after repair of anorectal malformations (ARMs).
METHODS: We retrospectively reviewed pediatric patients with fecal incontinence after ARM repair who underwent surgical intervention at Capital Institute of Pediatrics and Beijing Tsinghua Changgung Hospital between July 2017 and June 2025. Bowel function was compared before and after surgery using the Rintala score and Krickenbeck classification.
RESULTS: Twenty-two children underwent reoperation, including 19 males and 3 females. Surgical indications included anal malposition (n = 11, 50.0%), patulous anus (n = 10, 45.5%), rectal prolapse (n = 7, 31.8%), fistula recurrence (n = 2, 9.1%), megacolon (n = 2, 9.1%), and anal stenosis (n = 2, 9.1%). Procedures included isolated or combined sphincter reconstruction and laparoscopic Malone appendicostomy. At a median follow-up of 3.2 years, 18 patients (82%) showed improved Rintala scores. Krickenbeck assessment demonstrated improved soiling control (P = 0.0005) and increased voluntary bowel movements (P = 0.016).
CONCLUSION: Surgical correction of residual anatomical defects was associated with partial improvement in bowel function in selected children with fecal incontinence after ARM repair, but normal continence was uncommon. Malone appendicostomy or structured bowel management may be preferable in patients with poor sphincteric or neuromuscular reserve.