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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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. Can</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c421t-6334f717d61eafcd5d2a7960541f895d947d616425b945466b1852205a46217e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Abnormalities, Multiple - epidemiology</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Anal Canal - abnormalities</topic><topic>Anal Canal - physiopathology</topic><topic>Anal Canal - surgery</topic><topic>Anorectal malformations</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Colonic motility</topic><topic>Colonic transit time</topic><topic>Consensus</topic><topic>Constipation - epidemiology</topic><topic>Constipation - etiology</topic><topic>Constipation - physiopathology</topic><topic>Defecation</topic><topic>Diarrhea - epidemiology</topic><topic>Diarrhea - etiology</topic><topic>Diarrhea - physiopathology</topic><topic>Fecal Incontinence - epidemiology</topic><topic>Fecal Incontinence - etiology</topic><topic>Fecal Incontinence - physiopathology</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gastrointestinal Motility</topic><topic>Humans</topic><topic>Krickenbeck consensus</topic><topic>Male</topic><topic>Megacolon - epidemiology</topic><topic>Megacolon - physiopathology</topic><topic>Pediatrics</topic><topic>Postoperative Complications - epidemiology</topic><topic>Postoperative Complications - physiopathology</topic><topic>Practice Guidelines as Topic</topic><topic>Rectal Fistula - complications</topic><topic>Rectal Fistula - epidemiology</topic><topic>Rectum - abnormalities</topic><topic>Rectum - physiopathology</topic><topic>Rectum - surgery</topic><topic>Severity of Illness Index</topic><topic>Surgery</topic><topic>Volition</topic><topic>Voluntary bowel movements</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><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><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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