Outcome of anorectal myectomy in the treatment of internal anal sphincter achalasia in young adults.

Ismail Özerhan, MD, Nail Ersoz, MD, M.Fatih Can, MD, Gokhan Ya?c?, MD, Nihat Kaymakcioglu, MD, Murat Demiriz, MD, Yusuf Peker, MD

Department of Surgery, Gulhane Military Medical Academy, Ankara, Turkey.

OBJECTIVE:
Internal anal sphincter achalasia (IASA), also referred to as ultrashort segment Hirschsprung’s disease (HD), is a clinical condition with presentation similar to HD, but with the presence of ganglion cells on rectal biopsy. The nonserious forms of this congenital disease may reach the young by proceeding with chronic, obstinate constipation that does not respond to diet. Internal sphincter myectomy (ISM ) of the short segment of aganglionic part may provide diagnostic and therapeutic value. The present study aimed to evaluate the outcomes of anorectal myectomy in IASA.

PATIENTS, METHODS:
The medical records of 25 patients20 (male, 5 female) with IASA managed by ISM during 1993-2012 were examined. All patients presented with intractable constipation with or without soiling. The diagnosis of IASA is made on anorectal manometry, which shows the absence of anorectal inhibitor reflex (ARIR) .

RESULTS:
Difficulty in defecation was the most common symptom, followed by abdominal fullness, abdominal pain and soiling. In addition to the deficiency of ARIR among all patients, the frequency of defecation was 12.5 days (range, 6-30 ) before operation. Anorectal length before widening was an average of 5.6 cm (range, 2-8 ). All pathologic specimens were found to be hypo- aganglionic. Seven cases required resection of dilated and redundant sigmoid colon and now has normal bowel habits with laxatives. Spontaneous evacuation without the need for laxatives, suppositories, and enema was recorded in 100% patients of good outcome, and 44% those of satisfactory outcome after ISM . ARIR of patients also returned to normal.

CONCLUSION:
The majority of patients with internal anal sphincter achalasia can be treated successfully by ISM . ISM is an effective , the simple and complication-free procedure in diagnosis and treatment of internal anal sphincter achalasia IASA .

Session: Poster Presentation

Program Number: P111