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Updated: Aug 8, 2026
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
[Evaluation of late results in the children with anorectal anomalies]
1Klinika Chirurgii Dzieci i Młodziezy, Instytut Matki i Dziecka, ul. Kasprzaka 17a, 01-211 Warszawa, Poland.
Insights
One-stage repair (OSR) offers excellent functional outcomes for anorectal malformations, comparable to controls, especially when sacral bone defects are absent. Stage repair (SR) results are significantly influenced by sacral agenesis.
Area of Science:
- Pediatric Surgery
- Congenital Anomalies
- Functional Outcomes
Context:
- Anorectal malformations (ARMs) present diverse challenges in pediatric surgery.
- Optimizing functional results after surgical correction remains a key objective.
Purpose:
- To evaluate long-term functional outcomes following surgical treatment of pediatric anorectal anomalies.
- To assess the impact of surgical approach (one-stage vs. staged repair), age at treatment completion, and sacral bone defects on functional prognosis.
Summary:
- This study analyzed 60 children with ARMs, comparing one-stage repair (OSR) and staged repair (SR) groups, with a focus on sacral bone integrity and functional outcomes (fecal continence, manometry).
- OSR group showed 93% normal fecal continence, with outcomes not differing from controls. SR group had significantly poorer results (41% normal continence), strongly correlated with sacral bone defects.
- Sacral bone defects were present in 10% of OSR patients versus 73% of SR patients, significantly impacting manometric findings and overall functional results.
Impact:
- Identifies one-stage repair as a favorable option for anorectal malformations when specific criteria are met.
- Highlights the critical role of sacral bone development in predicting functional outcomes after anorectal malformation surgery.
- Provides evidence-based insights for surgical decision-making and patient selection in managing complex anorectal anomalies.
Unlabelled:
Anorectal malformations constitute the most varied group of congenital defects. Constant challenge for the surgeon being engaged in this subject are the studies of new factors which could improve the functional results of treatment.
Aim:
The aim of the study was the evaluation of late results after surgical treatment in children with anorectal anomalies. Assessment of the qualification criteria for the kind of surgical repair: one-stage (OSR) or stage repair (SR), age of the patient at the end of treatment and accompanying sacral bone defects were taken into consideration as the factors of functional prognosis.
Material And Methods:
93 children with different types of anorectal defects were operated on between 1990-2002 in Department of Pediatric Surgery in the Institute of Mother and Child. The evaluation was performed in 60 patients over 3 years old: in 30 after OSR (group I) and in 30 after SR proceeded by colostomy (group II). Anorectal malformations were classified according to Pena's division based on the place of fistula orifice. Most kinds of anorectal anomalies were operated on according to the principles of posterior sagital anorectoplasty (PSARP). In patients with congenital anal stenosis a modified cutback procedure was done. In long-term evaluation in every child precise diagnostics of sacral bone with definition of congenital sacral bone defects and sacral measurements were performed, in order to estimate their influence on the results of treatment of anorectal anomalies. In postoperative evaluation of functional results the following criteria were taken into consideration: physical examination, evaluation of fecal continence by using quantitative scoring method and manometric study. The control group included 20 children with constipation.
Results:
Sacral bone defects were diagnosed in 10% of the OSR group (group I) and in 73% of patients of the SR group (group II). Sacral measurements showed significant differences in SR group compared with OSR and control group. In clinical examination postoperative appearance of perineal and anal region depended on congenital development of perineal structure. In ST group of patients symptoms of 'flat perineum' were seen with various degree of muscles hypodevelopement, lack of perineal raphe and weakly marked anal dimple. Results of fecal continence in OSR group (group I) were defined as normal in 93% of patients and good in 7% of cases. In SR group (group II) the results were as following: normal in 41%, good in 17%, fair in 38% and poor in 4% of cases. The worst results were obtained in the patients with sacral defects in SR group. In manometric study there were no significant differences except for one parameter (anal resting pressure) between OSR group (group I) and the control group. In group II manometric study was different in three parameters: anal resting pressure, squeezing pressure and presence of internal sphincter reflex. The presence of sacral bone defects had the most important influence on manometric study results.
Conclusion:
Functional results in the OSR group of patients were not different from the control group. Precise criteria for this kind of surgical treatment and lack of serious sacral defects were the most important factors for good prognosis. The results of late evaluation in SR group depended on coexisting sacral bone agenesis.
