TRANSANAL INTERNAL SPHINCTER MYOMECTOMY - INDICATIONS, OPERATIVE PROCEDURE AND RESULTS

From October 1, 1981, until December 31, 1991, we performed clinical, radiological, electromanometrical, histochemical and histological diag nostic procedures in 906 patients under 15 years of age, because of se veral distinct colonic and anorectal disorders. 739 were clinically co nstipated and in 272 of them hypertonicity of the internal anal sphinc ter with or without achalasia could be demonstrated by manometry. 121 of these patients were submitted to a posterior, transanal, partially resective internal sphincteromyomectomy, according to a slightly modif ied classical procedure. Follow-up of our operated patients ranged fro m 1 month to 9 years, with a mean of 3 years and 2 months and overall satisfactory results in 87.6 % based on clinical evaluation. Additiona lly, 55.4 % of the operated patients had early postoperative manometri c controls (n = 67) and 77.6 % of these (n = 52) accepted a third mano metry, in order to evaluate late results of our procedure. We could de monstrate that early postoperative anorectal electromanometry shows a highly significant decrease of the internal anal sphincter pressure co rrelating with a clinical improvement in 98.5 % of these patients (n 6 7). Most late postoperative examinations showed recurrent elevation of the manometric internal sphincter pressure parameters, exceeding the mean values of our own normal controls. Nevertheless, clinically 98.1 % of these patients had a persistent satisfactory remission of their s ymptoms, thus not correlating with the manometric findings in these ca ses. We conclude, that transanal internal sphincter myomectomy is a sa fe surgical procedure, which leads to satisfactory results in approxim ately 90 % of ironically constipated children with anal sphincter hype rtonicity, if very precise indications for operation are considered.