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]

[1]	任平，张玉侠，陈劼，等. 肛门直肠畸形术后真性大便失禁患儿生活质量影响因素研究[J]. 护理学杂志，2018, 33(6): 27-31. DOI: 10.3870/j.issn.1001-4152.2018.06.027.
[2]	陈劼，任平，马丽丽，等. 真性大便失禁儿童的个体化肠道管理[J]. 护理学杂志，2017, 32(18): 32-35. DOI: 10.3870/j.issn.1001-4152.2017.18.032.
[3]	Walega P, Romaniszyn M, Siarkiewicz B, et al. Dynamic versus adynamic graciloplasty in treatment of end-stage fecal incontinence: is the implantation of the pacemaker really necessary? 12-month follow-up in a clinical, physiological, and functional study[J]. Gastroenterol Res Pract, 2015, 2015: 698516. DOI: 10.1155/2015/698516.
[4]	Margolin DA. New options for the treatment of fecal incontinence[J]. Ochsner J, 2008, 8(1): 18-24.
[5]	王勇，余家康，钟军，等. 肠道管理系统对小儿排粪失禁的治疗作用[J]. 中华胃肠外科杂志，2014, 17(7): 672-675. DOI: 10.3760/cma.j.issn.1671-0274.2014.07.011.
[6]	Rezvan A, Jakus-Waldman S, Abbas MA, et al. Review of the diagnosis, management and treatment of fecal incontinence[J]. Female Pelvic Med Reconstr Surg, 2015, 21(1): 8-17. DOI: 10.1097/SPV.0000000000000102.
[7]	Schell SR, Toogood GJ, Dudley NE. Control of fecal incontinence: continued success with the Malone procedure[J]. Surgery, 1997, 122(3): 626-631. DOI: 10.1016/s0039-6060(97)90137-9.
[8]	Denadai R, Raposo-Amaral CE, Sabbag A, et al. Measuring patient-reported health-related quality of life in velopharyngeal insufficiency: reliability and validity of the Brazilian Portuguese version of the VELO instrument[J]. Cleft Palate Craniofac J, 2019, 56(9): 1195-1205. DOI: 10.1177/1055665619846763.
[9]	de la Portilla F, Calero-Lillo A, Jiménez-Rodríguez RM, et al. Validation of a new scoring system: rapid assessment faecal incontinence score[J]. World J Gastrointest Surg, 2015, 7(9): 203-207. DOI: 10.4240/wjgs.v7.i9.203.
[10]	李小嘉，郭修田. 大便失禁的治疗现状[J]. 云南中医中药杂志，2015, 36(2): 70-72.
[11]	Feng X, Lacher M, Quitmann J, et al. Health-related quality of life and psychosocial morbidity in anorectal malformation and hirschsprung′s disease[J]. Eur J Pediatr Surg, 2020, 30(3): 279-286. DOI: 10.1055/s-0040-1713597.
[12]	Chaturvedi A, Franco A, Chaturvedi A, et al. Caudal cell mass developmental aberrations: an imaging approach[J]. Clin Imaging, 2018, 52: 216-225. DOI: 10.1016/j.clinimag.2018.07.014.
[13]	Koch SM, Uludağ O, El Naggar K, et al. Colonic irrigation for defecation disorders after dynamic graciloplasty[J]. Int J Colorectal Dis, 2008, 23(2): 195-200. DOI: 10.1007/s00384-007-0375-y.
[14]	Bischoff A, Levitt MA, Bauer C, et al. Treatment of fecal incontinence with a comprehensive bowel management program[J]. J Pediatr Surg, 2009, 44(6): 1278-1284. DOI: 10.1016/j.jpedsurg.2009.02.047.
[15]	Malone PS, Ransley PG, Kiely EM. Preliminary report: the antegrade continence enema[J]. Lancet, 1990, 336(8725): 1217-1218. DOI: 10.1016/0140-6736(90)92834-5.
[16]	Chatoorgoon K, Pena A, Lawal T, et al. Neoappendicostomy in the management of pediatric fecal incontinence[J]. J Pediatr Surg, 2011, 46(6): 1243-1249. DOI: 10.1016/j.jpedsurg.2011.03.059.
[17]	Lawal TA, Rangel SJ, Bischoff A, et al. Laparoscopic-assisted Malone appendicostomy in the management of fecal incontinence in children[J]. J Laparoendosc Adv Surg Tech A, 2011, 21(5): 455-459. DOI: 10.1089/lap.2010.0359.
[18]	孙小兵，李健，代晋宇，等. 腹腔镜技术在Malone可控性顺行灌肠术中的应用效果[J]. 中华普通外科杂志，2019, 34(1): 45-48. DOI: 10.3760/cma.j.issn.1007-631X.2019.01.012.

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