Faecal incontinence (FI) is defined as the inability to control bowel movements. The causes of FI are many and diverse. One of the more uncommon reasons for FI is Anorectal Malformations (ARMs). An ARM is a congenital anomaly that affects somewhere between 1/2500 and 1/5000 live born babies. Many ARM patients have persistent FI. Several different procedures have been utilised to address this issue. This thesis aims to evaluate (1) the long-term outcome in adulthood of ARMs in relation to the modern Krickenbeck classification, and (2) scope for treating FI with transanal injection with dextranomer in non-animal stabilised hyaluronic acid (NASHA/Dx), in patients both with and without ARMs. All patients treated for ARMs in Uppsala up to 1993 were invited to participate in a questionnaire study of quality of life and function. The study included 136 patients and compared them with 136 age- and sex-matched controls. The Krickenbeck classification was found to predict functional outcome, and ARM patients had more problems with incontinence and obstipation, as well as inferior Quality of Life (QoL), compared with controls.  Thirty-six patients with FI, owing to causes other than ARMs, were treated with transanal submucous injection of NASHA/Dx. The patients were monitored for two years after treatment. Significant reductions in both their incontinence score and the number of their incontinence episodes were achieved.  A significant improvement in QoL was observed in patients who had at least a 75% reduction in incontinence episodes. No serious complications occurred. A prospective study of transanal injection of NASHA/Dx was conducted on seven patients with persistent FI after ARMs. After six months a significant reduction in the number of incontinence episodes was obtained. A significant improvement in QoL was also found. No serious complications occurred. In conclusion, adult patients with ARMs have inferior outcome of anorectal function and QoL compared with controls. NASHA/Dx is effective and appears to be safe in treating FI in general. This effect seems to be the same in selected patients with persistent FI after ARMs.

Submitted by PPG Pediatria e Sa?de da Crian?a (pediatria-pg@pucrs.br) on 2018-01-02T13:03:25Z No. of bitstreams: 1 Disserta??o Final Leticia.pdf: 1205338 bytes, checksum: aaada41475481b359b67f59237a3954d (MD5) / Approved for entry into archive by Caroline Xavier (caroline.xavier@pucrs.br) on 2018-01-24T11:41:27Z (GMT) No. of bitstreams: 1 Disserta??o Final Leticia.pdf: 1205338 bytes, checksum: aaada41475481b359b67f59237a3954d (MD5) / Made available in DSpace on 2018-01-24T11:45:19Z (GMT). No. of bitstreams: 1 Disserta??o Final Leticia.pdf: 1205338 bytes, checksum: aaada41475481b359b67f59237a3954d (MD5) Previous issue date: 2017-08-25 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Introduction: The classifications of anorectal malformations were established with the objective for better classifying each type of malformation and allow the best choice for the surgical approach. With these classifications, it is possible to evaluate the surgical indications, predict how the child will respond to the procedure, as well as they allow comparative studies in different surgical centers. Objectives: The main objective of this work was a reassessment of the patients with anorectal malformations using the Krickenbeck?s classification in a hospital of reference in the south of Brazil. The aim was to compare these results with the previously used Pe?a?s classification to reevaluate the malformation cases, as well as the surgeries performed. Methods: It was performed a longitudinal, observational, descriptive, census, cohort study on the anorectal malformation cases between May 2017 and August 2017 at the Pediatric Surgery Service from the S?o Lucas Hospital from the PUCRS. The inclusion criteria was: a. all newborn children with anorectal malformations born in this hospital, b. transferred to this hospital with no previous procedure, and c. which performed a surgical procedure to correct the malformation in the first week of life in this hospital. a. Patients transferred from other hospitals with previous surgeries and b. patients which presented other malformations were excluded from the sample. A descriptive analysis of the incidence of different types of malformations and surgeries was performed and discussed. Results: Few differences were found between the classification of Pe?a and the classification of Krickenbeck. We found mainly cases of perineal, vestibular, retourethral, rectovaginal and cloaca fistula treated by means of colostomy surgeries and posterior sagittal anorectoplasty. Conclusions: The present study points out that there few differences between the Pe?a and Krickenbeck classifications. We suggest the use of a classification applied and based on the occurrence of cases of anorectal malformations in this service, containing the main relevant information of both classifications above. / Introdu??o: As classifica??es das malforma??es anorretais surgiram com o objetivo de melhor classificar cada malforma??o e com isso possibilitar a escolha da melhor abordagem cir?rgica. Atrav?s desses modelos ? poss?vel avaliar as indica??es cir?rgicas, tentar prever como a crian?a responder? ao procedimento e permitir que estudos sejam comparados em diferentes centros cir?rgicos. Objetivos: Reavaliar os pacientes com malforma??es anorretais pela classifica??o de Krickenbeck em Hospital de refer?ncia para esse tipo de anomalia no sul do Brasil. Comparar com a classifica??o previamente usada de Pe?a para avaliar as malforma??es e cirurgias realizadas. M?todos: Estudo de coorte, longitudinal, observacional, descritivo, de censo, foi realizado entre maio de 2017 e julho de 2017 no Servi?o de Cirurgia Pedi?trica do Hospital S?o Lucas da PUCRS. Os crit?rios de inclus?o foram: a. todas as crian?as rec?m-nascidas com malforma??es anorretais nascidas neste servi?o ou b. transferidas para o mesmo sem nenhum procedimento pr?vio; c. terem realizado procedimento cir?rgico para corre??o da malforma??o na primeira semana de vida neste servi?o. Foram exclu?dos a. os pacientes transferidos de outros hospitais com cirurgias pr?vias e b. os pacientes que apresentavam outras malforma??es com indica??es cir?rgicas. Foi realizada uma an?lise descritiva das incid?ncias dos diferentes tipos de malforma??o. Resultados: Encontraram-se poucas diferen?as entre a classifica??o de Pe?a e a classifica??o de Krickenbeck. Foram encontrados principalmente casos de f?stula perineal, vestibular, retouretral, retovaginal e cloaca tratados mojoritariamente atrav?s de cir?rgias de colostomia e anorretoplastia sagital posterior. Conclus?es: A presente pesquisa aponta que praticamente n?o h? diferen?as entre as classifica??es de Pe?a e Krickenbeck. Sugere-se a utiliza??o de uma classifica??o aplicada e baseada na ocorr?ncia dos casos de malforma??es anorretais neste servi?o, contendo as principais informa??es relevantes de ambas as classifica??es acima.