[Efficiency and limitations of Pickrell's anomyoplasty in treatment of postoperative incontinence in children with anorectal malformations (author's transl)]

Abstract

Eight children with high or intermediate anorectal malformations and fecal incontinence after primary repair were operated according the Pickrell technique. In 3 patients, the result of the Pickrell plasty was clinically not sufficient and the opposite gracilis muscle was used in addition at a second operative session. The 8 children were studied clinically, radiologically, by electromyography and manometry. The results are presented in detail. All 8 patients had a good passive continence at rest, but an active physiological continence could not be achieved. This seems to be due mainly to the absence of the internal anal sphincter, but partially also to the incomplete or even lacking adaptation of the pulled through bowel, which showed a relative hyperactivity and did not function as a neorectal reservoir. Some therapeutic measures to overcome the problems due to the fact that we deal at the same time with smooth and with striated muscles are discussed in the limelight of the present study.