Surgical methods for anorectal malformations from Rehbein to Peña--critical assessment of score systems and proposal for a new classification

In this review article the surgical techniques of Rehbein, Romualdi, Kiesewetter, and Peña/De Vries are compared and corresponding surgical steps are pointed out. Peña/De Vries have adopted many surgical steps from Stephens and further standardized this technique. The results of recent postoperative examinations are presented with regard to the surgical methods of Stephens, Rehbein, Romualdi, Kiesewetter, and Peña. In that connection, the paper makes it clear that comparison of postoperative studies is not possible because the authors evaluate too small numbers of cases, use different scoring systems, do not indicate individual steps of their surgical techniques and do not consider the height of the atresias. The reference to the type of fistula that can be found in recent literature unfortunately does not provide a common basis for comparative studies either. Therefore, the paper suggests complete abandonment of scoring systems and classification of postoperative continence results instead according to the therapy that has to be applied. In addition, it again stresses the importance and necessity of adhering to the Wingspread classification.