Anorectal malformations: definitive surgery during adulthood

Anorectal malformations (ARMs) are rarely seen in adults, since majority of cases are corrected in infancy or childhood. The aim of this study was to describe the profile of patients who underwent definitive surgery to correct their ARM in adulthood, and to discuss the outcomes of surgery (morbidity, mortality, and function).

This retrospective study included patients 18 years old and above, managed surgically by the Division of Colorectal Surgery at the Philippine General Hospital, University of the Philippines, Manila, from January 1, 2004, to December 31, 2012. Data from the Integrated Surgical Information System and the patients' hospital records were used to fill out a Data Collection Form. Frequencies and percentages were then computed.

Eight patients were included in the study. The most common reason for consult was recurrent urinary tract infection (UTI, 25%). One patient had an imperforate anus (IA) without a fistula, and 1 patient had IA with rectal atresia, and the 6 had an IA with a fistula. All but one (87.5%) of the patients had undergone a prior diversion in infancy or childhood. Definitive surgical procedures included posterior sagittal anorectoplasty (PSARP) in 3 patients, anal transposition in 2 patients, laparotomy with colocutaneous anastomosis in two patients, and laparotomy and PSARP in 1 patient. There were 3 cases (37.5%) of postoperative complications. These complications included ureteral injury, enterocutaneous fistula, anal stricture, rectal stricture, rectovesical fistula, and recurrent rectourethral fistula. There was no reported mortality. Five patients already had their stomas reversed at the time of this writing.

Our results showed that the rarity of the disease, limited surgical experience, and a technically challenging anatomy make the management of ARMs that persist into adulthood a formidable undertaking.