Abstract

Objective: The invastigating of secondary anal operations for patients who had anal atresia surgery.

Material and Methods: We evaluated 18 patients with ope- rated anal atresias who had a secondary anal operation between 1990-2010 in our clinic. This evaluation made by physical examination, anal MRI or CT, and sphincter test.

Results: Ages of the patients (10 male and 6 female) ranged from 2 to 18 years Median age for secondary operation was 5 years from the initial intervention. Mucoid leakage was the most common symptom for mucosal prolapse and two cases had anal incontinence. The main symptom of anal dislocation and inadequate anal sphincter was incontinence and the major finding was anal stricture for the patient who had strictureplasty. Indications for secondary operations consisted of mucosal prolapse (n:8), anal dislocation (n:5), incomplete anal sphincter (n:2) and anal stricture (n:1) The diagnosis was made by physical examination, MRI, CT, anal manometry and sphincterotest. Mucosal prolapses of 360 degrees in 5 and 180 degrees in 3 patients were excised. For the management of anal dislocations, anal transpositions wer achived using posterior (n:3), and anterior (n:2) anoplasties. Sphincteroplasty was performed for 2 patients with incomplete anal sphincters. Strictureplasty was used for 1 patient who did not respond to dilatation therapy. Mucosal excision provided complete surgical healing in mucosal prolapse but 2 cases required medical therapy for fecal incontinence. Three of 5 patients who had anal transpositiona were asymptomatic, while remaining 2 patients needed medical therapy occasionally. The cases who had sphincteroplasty and strictureplasty are asymptomatic in this series.

Conclusion: In these series mucosal prolapse was the most common rationale for secondary operation in cases with operated anal atresia.The excision of mucosal prolapse improved the cosmetic appearance; healed incontinence and corrected mucoid leakage. Before the secondary operation for anal dislocation and incomplete anal sphincter, all patients should be evaluated by radiological investigating,anal manometry and sphincter test. Choosing a suitable operation play the key role for treating incontinence.