Colonic motility and functional assessment of the patients with anorectal malformations according to Krickenbeck consensus

Abstract Background/Purpose In this study, the patients operated on for anorectal malformations (ARM) were evaluated in terms of segmental (SCTT) and total colonic transit times (TCTT) and clinical status according to Krickenbeck consensus before and after treatments. Methods Forty-one patients with...

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Veröffentlicht in:Journal of pediatric surgery 2008-10, Vol.43 (10), p.1839-1843
Hauptverfasser: Demirogullari, Billur, Ozen, I. Onur, Karabulut, Ramazan, Turkyilmaz, Zafer, Sonmez, Kaan, Kale, Nuri, Basaklar, A. Can
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container_end_page 1843
container_issue 10
container_start_page 1839
container_title Journal of pediatric surgery
container_volume 43
creator Demirogullari, Billur
Ozen, I. Onur
Karabulut, Ramazan
Turkyilmaz, Zafer
Sonmez, Kaan
Kale, Nuri
Basaklar, A. Can
description Abstract Background/Purpose In this study, the patients operated on for anorectal malformations (ARM) were evaluated in terms of segmental (SCTT) and total colonic transit times (TCTT) and clinical status according to Krickenbeck consensus before and after treatments. Methods Forty-one patients with ARM (28 males/13 females) older than 3 years (median age, 7.7 years; range, 3-25) who had no therapy before were assessed for voluntary bowel movements (VBM), soiling (from 1 to 3), and constipation (from 1 to 3), retrospectively. Distribution of the patients were rectourethral fistula (17), perineal fistula (PF; 8), vestibular fistula (VF; 8), cloaca (3), rectovesical fistula (1), rectovaginal fistula (1), pouch colon with colovestibular fistula (1), no fistula (1), and unknown (1). The patients ingested daily 20 radiopaque markers for 3 days, followed by a single abdominal x-ray on days 4 and 7 if needed. The results were compared with the reference values in the literature. Results Mean follow-up period was 36 months (range, 1-108.5 months). All patients but 1 had soiling in different degrees. Twenty-one patients who had VBM were divided into group 1, with constipation (n = 9), and group 2, without constipation (n = 12). The other 19 patients who had no VBM were divided into group 3, with constipation (n = 14), and group 4, without constipation (n = 5). The longest TCTT and rectosigmoid SCTT were found in group 3 (69.5 and 35.2 hours, respectively). Group 1 had long SCTT in rectosigmoid but normal TCTT (27.8 and 47.4 hours, respectively). Groups 2 and 4 had normal SCTT and TCTT, and there was no significant difference between them. After the appropriate treatment, of the patients, 45% (18/40) had no soiling, and the soiling score decreased to grade 1 in 27.5% (11/40) and to grade 2 in 10% (4/40). Four had unchanged soiling score, and 3 were excluded from the study because of follow-up problems. Half of the patients in group 3 (4 VF, 2 rectourethral fistula, PF) gained VBM without soiling after laxative treatment. Only four of 23 patients had decreased constipation score (2 cloaca, PF, VF). Conclusions In this study, ARM patients complaining of constipation with or without VBM had prolonged SCTT in the rectosigmoid region. Percentage of the improvement in soiling scores was more conspicuous than that of constipation scores. The dismal figure observed at the first examination in the assessment of VBM was not associated with an unfavorable improvement with laxa
doi_str_mv 10.1016/j.jpedsurg.2008.01.055
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Onur ; Karabulut, Ramazan ; Turkyilmaz, Zafer ; Sonmez, Kaan ; Kale, Nuri ; Basaklar, A. Can</creator><creatorcontrib>Demirogullari, Billur ; Ozen, I. Onur ; Karabulut, Ramazan ; Turkyilmaz, Zafer ; Sonmez, Kaan ; Kale, Nuri ; Basaklar, A. Can</creatorcontrib><description>Abstract Background/Purpose In this study, the patients operated on for anorectal malformations (ARM) were evaluated in terms of segmental (SCTT) and total colonic transit times (TCTT) and clinical status according to Krickenbeck consensus before and after treatments. Methods Forty-one patients with ARM (28 males/13 females) older than 3 years (median age, 7.7 years; range, 3-25) who had no therapy before were assessed for voluntary bowel movements (VBM), soiling (from 1 to 3), and constipation (from 1 to 3), retrospectively. Distribution of the patients were rectourethral fistula (17), perineal fistula (PF; 8), vestibular fistula (VF; 8), cloaca (3), rectovesical fistula (1), rectovaginal fistula (1), pouch colon with colovestibular fistula (1), no fistula (1), and unknown (1). The patients ingested daily 20 radiopaque markers for 3 days, followed by a single abdominal x-ray on days 4 and 7 if needed. The results were compared with the reference values in the literature. Results Mean follow-up period was 36 months (range, 1-108.5 months). All patients but 1 had soiling in different degrees. Twenty-one patients who had VBM were divided into group 1, with constipation (n = 9), and group 2, without constipation (n = 12). The other 19 patients who had no VBM were divided into group 3, with constipation (n = 14), and group 4, without constipation (n = 5). The longest TCTT and rectosigmoid SCTT were found in group 3 (69.5 and 35.2 hours, respectively). Group 1 had long SCTT in rectosigmoid but normal TCTT (27.8 and 47.4 hours, respectively). Groups 2 and 4 had normal SCTT and TCTT, and there was no significant difference between them. After the appropriate treatment, of the patients, 45% (18/40) had no soiling, and the soiling score decreased to grade 1 in 27.5% (11/40) and to grade 2 in 10% (4/40). Four had unchanged soiling score, and 3 were excluded from the study because of follow-up problems. Half of the patients in group 3 (4 VF, 2 rectourethral fistula, PF) gained VBM without soiling after laxative treatment. Only four of 23 patients had decreased constipation score (2 cloaca, PF, VF). Conclusions In this study, ARM patients complaining of constipation with or without VBM had prolonged SCTT in the rectosigmoid region. Percentage of the improvement in soiling scores was more conspicuous than that of constipation scores. The dismal figure observed at the first examination in the assessment of VBM was not associated with an unfavorable improvement with laxative treatment. So, it is suggested that assessment of VBM initially may be deceptive for clinical status.</description><identifier>ISSN: 0022-3468</identifier><identifier>EISSN: 1531-5037</identifier><identifier>DOI: 10.1016/j.jpedsurg.2008.01.055</identifier><identifier>PMID: 18926217</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Abnormalities, Multiple - epidemiology ; Adolescent ; Adult ; Anal Canal - abnormalities ; Anal Canal - physiopathology ; Anal Canal - surgery ; Anorectal malformations ; Child ; Child, Preschool ; Colonic motility ; Colonic transit time ; Consensus ; Constipation - epidemiology ; Constipation - etiology ; Constipation - physiopathology ; Defecation ; Diarrhea - epidemiology ; Diarrhea - etiology ; Diarrhea - physiopathology ; Fecal Incontinence - epidemiology ; Fecal Incontinence - etiology ; Fecal Incontinence - physiopathology ; Female ; Follow-Up Studies ; Gastrointestinal Motility ; Humans ; Krickenbeck consensus ; Male ; Megacolon - epidemiology ; Megacolon - physiopathology ; Pediatrics ; Postoperative Complications - epidemiology ; Postoperative Complications - physiopathology ; Practice Guidelines as Topic ; Rectal Fistula - complications ; Rectal Fistula - epidemiology ; Rectum - abnormalities ; Rectum - physiopathology ; Rectum - surgery ; Severity of Illness Index ; Surgery ; Volition ; Voluntary bowel movements ; Young Adult</subject><ispartof>Journal of pediatric surgery, 2008-10, Vol.43 (10), p.1839-1843</ispartof><rights>2008</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c421t-6334f717d61eafcd5d2a7960541f895d947d616425b945466b1852205a46217e3</citedby><cites>FETCH-LOGICAL-c421t-6334f717d61eafcd5d2a7960541f895d947d616425b945466b1852205a46217e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.jpedsurg.2008.01.055$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18926217$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Demirogullari, Billur</creatorcontrib><creatorcontrib>Ozen, I. Onur</creatorcontrib><creatorcontrib>Karabulut, Ramazan</creatorcontrib><creatorcontrib>Turkyilmaz, Zafer</creatorcontrib><creatorcontrib>Sonmez, Kaan</creatorcontrib><creatorcontrib>Kale, Nuri</creatorcontrib><creatorcontrib>Basaklar, A. Can</creatorcontrib><title>Colonic motility and functional assessment of the patients with anorectal malformations according to Krickenbeck consensus</title><title>Journal of pediatric surgery</title><addtitle>J Pediatr Surg</addtitle><description>Abstract Background/Purpose In this study, the patients operated on for anorectal malformations (ARM) were evaluated in terms of segmental (SCTT) and total colonic transit times (TCTT) and clinical status according to Krickenbeck consensus before and after treatments. Methods Forty-one patients with ARM (28 males/13 females) older than 3 years (median age, 7.7 years; range, 3-25) who had no therapy before were assessed for voluntary bowel movements (VBM), soiling (from 1 to 3), and constipation (from 1 to 3), retrospectively. Distribution of the patients were rectourethral fistula (17), perineal fistula (PF; 8), vestibular fistula (VF; 8), cloaca (3), rectovesical fistula (1), rectovaginal fistula (1), pouch colon with colovestibular fistula (1), no fistula (1), and unknown (1). The patients ingested daily 20 radiopaque markers for 3 days, followed by a single abdominal x-ray on days 4 and 7 if needed. The results were compared with the reference values in the literature. Results Mean follow-up period was 36 months (range, 1-108.5 months). All patients but 1 had soiling in different degrees. Twenty-one patients who had VBM were divided into group 1, with constipation (n = 9), and group 2, without constipation (n = 12). The other 19 patients who had no VBM were divided into group 3, with constipation (n = 14), and group 4, without constipation (n = 5). The longest TCTT and rectosigmoid SCTT were found in group 3 (69.5 and 35.2 hours, respectively). Group 1 had long SCTT in rectosigmoid but normal TCTT (27.8 and 47.4 hours, respectively). Groups 2 and 4 had normal SCTT and TCTT, and there was no significant difference between them. After the appropriate treatment, of the patients, 45% (18/40) had no soiling, and the soiling score decreased to grade 1 in 27.5% (11/40) and to grade 2 in 10% (4/40). Four had unchanged soiling score, and 3 were excluded from the study because of follow-up problems. Half of the patients in group 3 (4 VF, 2 rectourethral fistula, PF) gained VBM without soiling after laxative treatment. Only four of 23 patients had decreased constipation score (2 cloaca, PF, VF). Conclusions In this study, ARM patients complaining of constipation with or without VBM had prolonged SCTT in the rectosigmoid region. Percentage of the improvement in soiling scores was more conspicuous than that of constipation scores. The dismal figure observed at the first examination in the assessment of VBM was not associated with an unfavorable improvement with laxative treatment. So, it is suggested that assessment of VBM initially may be deceptive for clinical status.</description><subject>Abnormalities, Multiple - epidemiology</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Anal Canal - abnormalities</subject><subject>Anal Canal - physiopathology</subject><subject>Anal Canal - surgery</subject><subject>Anorectal malformations</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Colonic motility</subject><subject>Colonic transit time</subject><subject>Consensus</subject><subject>Constipation - epidemiology</subject><subject>Constipation - etiology</subject><subject>Constipation - physiopathology</subject><subject>Defecation</subject><subject>Diarrhea - epidemiology</subject><subject>Diarrhea - etiology</subject><subject>Diarrhea - physiopathology</subject><subject>Fecal Incontinence - epidemiology</subject><subject>Fecal Incontinence - etiology</subject><subject>Fecal Incontinence - physiopathology</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastrointestinal Motility</subject><subject>Humans</subject><subject>Krickenbeck consensus</subject><subject>Male</subject><subject>Megacolon - epidemiology</subject><subject>Megacolon - physiopathology</subject><subject>Pediatrics</subject><subject>Postoperative Complications - epidemiology</subject><subject>Postoperative Complications - physiopathology</subject><subject>Practice Guidelines as Topic</subject><subject>Rectal Fistula - complications</subject><subject>Rectal Fistula - epidemiology</subject><subject>Rectum - abnormalities</subject><subject>Rectum - physiopathology</subject><subject>Rectum - surgery</subject><subject>Severity of Illness Index</subject><subject>Surgery</subject><subject>Volition</subject><subject>Voluntary bowel movements</subject><subject>Young Adult</subject><issn>0022-3468</issn><issn>1531-5037</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkU9v1DAQxS1ERZfCV6h84pZgO7GTXBBoVf6ISj0AZ8trT1pnk3jxOKDl09fRLkLi0pM1nvdmNL9HyDVnJWdcvR3K4QAOl3hfCsbakvGSSfmMbLiseCFZ1TwnG8aEKKpatZfkJeLAWP5m_AW55G0nlODNhvzZhjHM3tIpJD_6dKRmdrRfZpt8mM1IDSIgTjAnGnqaHoAeTPK5RPrbp4csDxFsysrJjH2Ik1mNSI21ITo_39MU6Nfo7R7mHdg9tbkLMy74ilz0ZkR4fX6vyI-PN9-3n4vbu09fth9uC1sLngpVVXXf8MYpDqa3Tjphmk4xWfO-7aTr6rWlaiF3XS1rpXa8lUIwaer1RKiuyJvT3EMMPxfApCePFsbRzBAW1KpTjapklYXqJLQxIEbo9SH6ycSj5kyv1PWg_1LXK3XNuM7Us_H6vGHZTeD-2c6Ys-D9SQD5zl8eokabGVpwfoWnXfBP73j33wg7-hycGfdwBBzCEnNcqLlGoZn-tma_Rs_aHHuruuoR_bytyw</recordid><startdate>20081001</startdate><enddate>20081001</enddate><creator>Demirogullari, Billur</creator><creator>Ozen, I. Onur</creator><creator>Karabulut, Ramazan</creator><creator>Turkyilmaz, Zafer</creator><creator>Sonmez, Kaan</creator><creator>Kale, Nuri</creator><creator>Basaklar, A. Can</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20081001</creationdate><title>Colonic motility and functional assessment of the patients with anorectal malformations according to Krickenbeck consensus</title><author>Demirogullari, Billur ; Ozen, I. Onur ; Karabulut, Ramazan ; Turkyilmaz, Zafer ; Sonmez, Kaan ; Kale, Nuri ; Basaklar, A. 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Onur</creatorcontrib><creatorcontrib>Karabulut, Ramazan</creatorcontrib><creatorcontrib>Turkyilmaz, Zafer</creatorcontrib><creatorcontrib>Sonmez, Kaan</creatorcontrib><creatorcontrib>Kale, Nuri</creatorcontrib><creatorcontrib>Basaklar, A. Can</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of pediatric surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Demirogullari, Billur</au><au>Ozen, I. Onur</au><au>Karabulut, Ramazan</au><au>Turkyilmaz, Zafer</au><au>Sonmez, Kaan</au><au>Kale, Nuri</au><au>Basaklar, A. Can</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Colonic motility and functional assessment of the patients with anorectal malformations according to Krickenbeck consensus</atitle><jtitle>Journal of pediatric surgery</jtitle><addtitle>J Pediatr Surg</addtitle><date>2008-10-01</date><risdate>2008</risdate><volume>43</volume><issue>10</issue><spage>1839</spage><epage>1843</epage><pages>1839-1843</pages><issn>0022-3468</issn><eissn>1531-5037</eissn><abstract>Abstract Background/Purpose In this study, the patients operated on for anorectal malformations (ARM) were evaluated in terms of segmental (SCTT) and total colonic transit times (TCTT) and clinical status according to Krickenbeck consensus before and after treatments. Methods Forty-one patients with ARM (28 males/13 females) older than 3 years (median age, 7.7 years; range, 3-25) who had no therapy before were assessed for voluntary bowel movements (VBM), soiling (from 1 to 3), and constipation (from 1 to 3), retrospectively. Distribution of the patients were rectourethral fistula (17), perineal fistula (PF; 8), vestibular fistula (VF; 8), cloaca (3), rectovesical fistula (1), rectovaginal fistula (1), pouch colon with colovestibular fistula (1), no fistula (1), and unknown (1). The patients ingested daily 20 radiopaque markers for 3 days, followed by a single abdominal x-ray on days 4 and 7 if needed. The results were compared with the reference values in the literature. Results Mean follow-up period was 36 months (range, 1-108.5 months). All patients but 1 had soiling in different degrees. Twenty-one patients who had VBM were divided into group 1, with constipation (n = 9), and group 2, without constipation (n = 12). The other 19 patients who had no VBM were divided into group 3, with constipation (n = 14), and group 4, without constipation (n = 5). The longest TCTT and rectosigmoid SCTT were found in group 3 (69.5 and 35.2 hours, respectively). Group 1 had long SCTT in rectosigmoid but normal TCTT (27.8 and 47.4 hours, respectively). Groups 2 and 4 had normal SCTT and TCTT, and there was no significant difference between them. After the appropriate treatment, of the patients, 45% (18/40) had no soiling, and the soiling score decreased to grade 1 in 27.5% (11/40) and to grade 2 in 10% (4/40). Four had unchanged soiling score, and 3 were excluded from the study because of follow-up problems. Half of the patients in group 3 (4 VF, 2 rectourethral fistula, PF) gained VBM without soiling after laxative treatment. Only four of 23 patients had decreased constipation score (2 cloaca, PF, VF). Conclusions In this study, ARM patients complaining of constipation with or without VBM had prolonged SCTT in the rectosigmoid region. Percentage of the improvement in soiling scores was more conspicuous than that of constipation scores. The dismal figure observed at the first examination in the assessment of VBM was not associated with an unfavorable improvement with laxative treatment. So, it is suggested that assessment of VBM initially may be deceptive for clinical status.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>18926217</pmid><doi>10.1016/j.jpedsurg.2008.01.055</doi><tpages>5</tpages></addata></record>
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subjects Abnormalities, Multiple - epidemiology
Adolescent
Adult
Anal Canal - abnormalities
Anal Canal - physiopathology
Anal Canal - surgery
Anorectal malformations
Child
Child, Preschool
Colonic motility
Colonic transit time
Consensus
Constipation - epidemiology
Constipation - etiology
Constipation - physiopathology
Defecation
Diarrhea - epidemiology
Diarrhea - etiology
Diarrhea - physiopathology
Fecal Incontinence - epidemiology
Fecal Incontinence - etiology
Fecal Incontinence - physiopathology
Female
Follow-Up Studies
Gastrointestinal Motility
Humans
Krickenbeck consensus
Male
Megacolon - epidemiology
Megacolon - physiopathology
Pediatrics
Postoperative Complications - epidemiology
Postoperative Complications - physiopathology
Practice Guidelines as Topic
Rectal Fistula - complications
Rectal Fistula - epidemiology
Rectum - abnormalities
Rectum - physiopathology
Rectum - surgery
Severity of Illness Index
Surgery
Volition
Voluntary bowel movements
Young Adult
title Colonic motility and functional assessment of the patients with anorectal malformations according to Krickenbeck consensus
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