CONSERVATIVE MANAGEMENT OF ANTERIOR LOCATED ANUS: A MEDIUM-LONG TERM FOLLOW UP
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In brief
In brief
Long-term study of 53 female patients with anterior anus managed conservatively without surgery shows excellent outcomes, with 90% having normal bowel function and post-menarchal adolescents showing no gynecologic complications. Results support non-surgical approach for this anatomic variant.
Written by the GCMD Library team from the article.
ABSTRACT
Background/Purpose
The anterior anus (AA) is a condition, almost exclusively present in females, in which the anus is located abnormally anterior along the perineal body, well separated from the vulva. Definition and treatment are still controversial. This study aimed to evaluate the medium-long term follow up of patients with AA conservatively managed, considering the gynaecologic aspects in post-menarchal girls.
Matherials/Methods
This cross-sectional study includes AA patients older than 3 years at time of the study, followed in two referral centres for ARM between January 2000 and May 2017. The API (Anal Position Index) was applied to define AA. A questionnaire regarding the ano-rectal function, occurrence of urinary infection (UTI), familiarity for ARM/AA was administered to parents and patients. Gynecological examination was performed in post-menarchal patients.
Results
Fifty-three patients (all females) were retrieved. Three were excluded (2 underwent surgery at another center, 1 was lost at follow-up), 7/50 had major malformations (2 oesophageal atresia, 4 cardiovascular malformations and 1 with Fallot, uretheral duplicity and vertebral anomalies), 5/50 had familiarity for ARM/AA. Only 10% were constipated. Fifteen patients underwent gynaecological examination. Their mean API was 0.278 +/- 0.013 DS, they had good buttock tropism, normal resident bacteria, and no UTI.
Conclusion
AA patients in our centers do not undergo any kind of surgery. At least three quarters of them have a perfectly normal bowel habits and adolescents do not present symptoms related to their condition. These results support the conservative management of this condition.