Our Summary

This research paper looks at a condition called tethered cord (TC) which is common in patients with anorectal malformations (ARMs), a kind of birth defect. TC can cause problems with bowel and bladder control. The study is trying to find out if an operation to untether the cord can improve these issues.

The researchers looked at a group of patients, who were more than 3 years old, had ARMs, suffered from fecal incontinence (inability to control bowel movements), and had undergone this operation between 2016 and 2020. They followed up with these patients for at least 6 months after their surgery.

Out of the 27 patients they studied, they found that after the surgery, 5 patients (18%) had some improvement in bowel control, 10 patients (37%) had total control, but 12 patients (44%) still had no control. Four patients (14%) had some improvement in bladder control, while the number of patients with total bladder control rose from 7 (25%) to 15 (55%). Symptoms in the lower extremities also improved in 72% of the cases.

Interestingly, they found that patients who had slow-moving colons (colonic hypomotility) had better results than those with fast-moving colons (colonic hypermotility). The researchers concluded that this surgery can significantly improve bowel and bladder control in patients with ARMs and fecal incontinence. Also, they found that the sacral ratio (a measure of the development of the sacral bone) didn’t affect the results.

FAQs

  1. What is the purpose of detethering surgery in patients with anorectal malformations (ARMs) and tethered cord (TC)?
  2. What improvements were observed in patients who underwent detethering surgery in terms of bowel and bladder control?
  3. Is there a relationship between sacral ratio and the success of detethering surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about detethering surgery is to have realistic expectations about the potential outcomes. While the surgery can lead to improved bowel and bladder control, it may not completely eliminate all symptoms of incontinence. It is important to follow post-operative care instructions and attend follow-up appointments to monitor progress and address any concerns. Additionally, maintaining a healthy lifestyle, including regular exercise and a balanced diet, can help support the healing process and overall well-being.

Suitable For

Patients who are typically recommended detethering surgery are those with anorectal malformations (ARMs) who also have tethered cord (TC) and experience fecal and urinary incontinence. This study specifically looked at TC patients over 3 years old with ARMs who underwent detethering surgery between 2016 and 2020. It was found that detethering surgery led to improved bowel and bladder control in these patients, with some achieving partial or total continence. Patients with colonic hypomotility were found to have a better functional outcome compared to those with colonic hypermotility.

Timeline

  • Before detethering surgery:
  1. Patient is diagnosed with anorectal malformations (ARMs) and tethered cord (TC).
  2. Patient may experience fecal and urinary incontinence.
  3. Patient undergoes evaluation, including sacral ratio measurement and assessment of colonic motility.
  4. Decision is made to undergo detethering surgery.
  • After detethering surgery:
  1. Surgery is performed on the patient.
  2. Patient is monitored post-operatively for complications and recovery.
  3. Patient experiences improvements in bowel and bladder control.
  4. Some patients achieve partial or total fecal continence.
  5. Some patients achieve partial or total urinary continence.
  6. Lower extremity symptoms may also improve.
  7. Patients with colonic hypomotility have better functional outcomes compared to those with colonic hypermotility.
  8. Patients are followed up for at least 6 months to assess long-term outcomes.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with detethering surgery?
  2. How long is the recovery process after detethering surgery?
  3. How likely is it that detethering surgery will improve my fecal and urinary incontinence symptoms?
  4. Are there any alternative treatments or therapies that I should consider before opting for detethering surgery?
  5. Will I need any additional follow-up appointments or treatments after the surgery?
  6. How experienced are you in performing detethering surgery for patients with anorectal malformations?
  7. Are there any specific lifestyle changes or accommodations I should make after the surgery to optimize the results?
  8. What is the success rate of detethering surgery for patients with similar conditions to mine?
  9. How long do the effects of detethering surgery typically last?
  10. Are there any long-term complications or considerations I should be aware of after undergoing detethering surgery?

Reference

Authors: Fernandez-Portilla E, Moreno-Acosta L, Dominguez-Muñoz A, Gonzalez-Carranza V, Chico-Ponce de Leon F, Davila-Perez R. Journal: Pediatr Surg Int. 2021 Apr;37(4):419-424. doi: 10.1007/s00383-020-04834-6. Epub 2021 Jan 11. PMID: 33427923