A comparison of clinical protocols for assessing postoperative fecal continence in anorectal malformation

We compared four protocols for assessing fecal continence (FC) in anorectal malformation (ARM).

Of 111 ARM cases we treated by anoplasty from 1995 to 2007, 59 have been followed up for more than 4 years [male high (n = 23), male low (n = 12), female high (n = 7), and female low (n = 17)] and 27 for more than 7 years [male high (n = 11), male low (n = 5), female high (n = 5), and female low (n = 6)]. FC was assessed in these 86 cases using each of the four protocols; the Kelly score (0-6 points), the Japanese Study Group of Anorectal Anomalies (JSGA) score (0-8 points), the Holschneider score (0-14 points), and our original score (0-10 points). Results were re-classified into four outcome levels (good, fair, poor, very poor) for direct comparison.

Outcome was different by two levels (i.e., good vs. very poor) in 7 (8.1%) assessments and different by one category (i.e., fair vs. poor) in ten assessments (11.6%). Outcome was different most often in male high ARM cases and JSGA scores were most divergent.

Fecal continence in male high ARM appears to be assessed inconsistently and a review of protocols may be of value to standardize clinical assessment and enhance reliability.