Medical and surgical management of fecal incontinence after repair of high imperforate anus anomalies

OBJECTIVE: To report the medical and surgical management of fecal incontinence in children after repair of high imperforate anus.

METHODS: Thirty-seven children with fecal incontinence post repair of high imperforate anus were recruited between January 2000 and July 2007 at Aseer General Hospital, Abha, and Alhada Military Hospital, Taif, Kingdom of Saudi Arabia. The decision for surgery (dynamic graciloplasty) was based on the degree of incontinence and failure to respond to medical treatment. Five children were operated from the start according to the input of history, examination, and investigations (incontinence score of 15-20). The remaining 32 patients were treated medically. Those cases that failed to respond to medical treatment had alternatively biofeedback therapy. Cases that failed to respond to biofeedback therapy underwent surgery.

RESULTS: Response to medical treatment is favorable (71%). Biofeedback showed discouraging results (22%). Dynamic graciloplasty showed excellent outcome (100% improvement in continence on long term follow up).

CONCLUSION: Based on history, examination, and investigations, recruited cases were primarily treated medically; those who had failed the medical treatment approach had dynamic graciloplasty, which demonstrated excellent results during the 1-7 years follow-up period.