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Updated: Sep 13, 2025
Vessel-sparing Excision and Primary Anastomosis
Published on: January 7, 2019
Postoperative Continence Assessment in Female Patients with Anorectal Malformations: A Tertiary Care Center Study
Anjana Kaza1, K T Mandakini1, Bhuvaneshwar Rao1
1Department of Pediatric Surgery, Osmania Medical College, Hyderabad, Telangana, India.
Insights
Most female patients with anorectal malformations (ARMs) achieve voluntary bowel movements after repair. Constipation is the most common complication, but targeted management improves outcomes.
Area of Science:
- Pediatric Surgery
- Congenital Anomalies
- Gastroenterology
Background:
- Anorectal malformations (ARMs) are congenital anomalies impacting the distal anorectum and often the urogenital tract.
- Improved survival rates in ARM patients necessitate a focus on optimizing bowel function for enhanced quality of life.
Purpose of the Study:
- To evaluate bowel functional outcomes in female patients with different types of anorectal malformations (ARMs) following standardized surgical management.
- To assess the effectiveness of the Krickenbeck scoring system in identifying functional incontinence post-ARM repair.
Main Methods:
- Retrospective analysis of 35 female patients (>3 years) with ARMs who underwent repair and completed a dilatation program.
- Assessment of bowel function using the Krickenbeck scoring system; contrast enema and MRI pelvis for continence issues.
- Data collected included demographics, ARM type, surgical procedures, and postoperative complications.
Main Results:
- Voluntary bowel movement (VBM) achieved in 97.15% of patients post-ARM repair.
- Constipation occurred in 22.85% and soiling in 5.7% of patients; soiling was linked to overflow incontinence.
- Abnormal findings on contrast enema (3 patients) and MRI pelvis (2 patients) were noted in those with continence issues.
Conclusions:
- The majority of female patients achieve VBM after ARM repair, with constipation being the primary functional complication.
- Early, targeted bowel management strategies are crucial for improving functional outcomes in pediatric patients with ARMs.
- The Krickenbeck scoring system provides a straightforward method for identifying patients experiencing functional incontinence post-ARM repair.
Background:
Anorectal malformations (ARMs) include a group of congenital anomalies affecting the distal anorectum with frequent involvement of the urogenital tract. As modern surgical advancements have improved survival, attention has shifted toward assessment and optimization of bowel function, to improve the overall quality of life for affected children.
Objective:
The objective of this study was to evaluate the bowel functional outcomes for individual types of female ARMs after standardized management at a tertiary center.
Materials And Methods:
The present study included 35 female patients with anorectal malformations aged >3 years, who underwent single staged/staged ARM repair, and finished dilatation program. Patient demographics, type of ARM, surgeries performed, and postoperative complications were noted. Bowel function was assessed using the Krickenbeck scoring system for postoperative results. Those with continence issues underwent contrast enema and magnetic resonance imaging (MRI) pelvis.
Results:
The study included 24 patients with vestibular fistula, 7 with perineal fistula, 2 with rectovaginal fistula, and 2 with perineal canal. Voluntary bowel movement (VBM) was achieved in 34 (97.15%) patients post-ARM repair, constipation in 8 (22.85%) patients, and soiling in 2 (5.7%) patients. Of these, 3 patients had abnormal findings on contrast enema and 2 on MRI pelvis.
Conclusion:
VBM was achieved by majority of the females following ARM repair. Constipation was the most common functional complication. Soiling noted in 2 cases was due to overflow incontinence secondary to constipation. Early initiation of targeted bowel management showed improvement in affected subjects. The Krickenbeck scoring system for postoperative results is a quick, easy method of identifying patients with functional incontinence based on symptoms.
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