Treatment of organic fecal incontinence in children with Malone operation combined with bowel management program

doi:10.3877/cma.j.issn.1673-5250.2021.06.015

Objective

To investigate effect of Malone operation combined with bowel management program in treatment of organic fecal incontinence (FI) in children on their defecation function and quality of life (QoL).

Methods

From January 2017 to January 2020, a total of 9 children with organic FI treated by this integrated scheme in Guangzhou Women and Children′s Medical Center were selected as research subjects, and their clinical case data were analyzed retrospectively. Schell scale was used to evaluate effect of Malone operation. Pediatric quality of life inventory (PedsQL) 4.0 was used to evaluate the QoL of children before and after treatment, and the rapid assessment of fecal incontinence scale (RAFIS) was used to evaluate defecation function of children before and after treatment. These three scales were used to evaluate the clinical effect of Malone operation combined with bowel management program in treatment of children with organic FI. The PedsQL 4.0 and RAFIS scores between before and after treatment of children were compared statistically by paired t test. This study was in line with World Medical Association Declaration of Helsinki revised in 2013 and informed contents were obtained from all guardians.

Results

① After 9 children were treated with Malone operation combined with bowel management program, 1 case (11.1%) did not have perianal feces, and 5 cases (55.6%) still had perianal feces (< once a week); One case (11.1%) had stricture of stoma with perianal feces (> twice a week); the other 2 cases (22.2%) had stoma infection or retraction with perianal feces (all < once/week). None of 9 children had other complications after Malone operation. ② Among the 9 children, 8 cases (88.9%) had a postoperative Schell score of (23.4±1.0) scores, and 1 case (11.1%) had 14.0 scores. The scores of PedsQL 4.0 and RAFIS of 9 children before treatment were (19.4±9.0) scores and (18.7±0.9) scores respectively, which were significantly higher than those of (4.0±4.0) scores and (3.6±2.3) scores after treatment, and the differences were statistically significant (t=5.907, P=0.004; t=18.338, P<0.001).

Conclusions

Malone operation combined with bowel management program in treatment of children with organic FI can greatly improve their QoL and has good clinical efficacy. It is an optional method for treatment of children with organic FI at present.

Key words: Fecal incontinence, Malone operation, Bowel management program, Enema, Quality of life, Child

图1 1例大便失禁患儿(5岁，男性)腹腔镜Malone手术主要操作[图1A、1B：建立抗反流瓣(白色箭头所示)；图1C：脐部皮肤的V型皮瓣；图1D：腹腔镜Malone手术后腹部伤口，脐部采用8Fr单腔导尿管作为支架管放置14 d]

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