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Anorectal malformations

A Peña1

  • 1Department of Surgery, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, NY 11040, USA.

Seminars in Pediatric Surgery
|February 1, 1995
PubMed
Summary
This summary is machine-generated.

The posterior sagittal approach successfully treated anorectal malformations in 792 patients, with 74.3% achieving voluntary bowel movements. Functional prognosis is improved by accurate sacral evaluation and medical treatment for disorders.

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Area of Science:

  • Pediatric Surgery
  • Colorectal Surgery
  • Congenital Malformations

Background:

  • Anorectal malformations (ARMs) are complex congenital anomalies requiring surgical intervention.
  • The posterior sagittal approach is a common surgical technique for ARM repair.
  • Long-term functional outcomes, including continence, are critical for quality of life.

Purpose of the Study:

  • To evaluate the long-term functional outcomes of patients with anorectal malformations treated with the posterior sagittal approach.
  • To assess the rates of voluntary bowel movements, soiling, constipation, and urinary incontinence based on ARM diagnosis.
  • To determine the correlation between sacral evaluation and functional prognosis.

Main Methods:

  • Retrospective review of 792 patients treated with the posterior sagittal approach for anorectal malformations.

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  • Detailed evaluation of 387 patients from 6 months to 13 years post-surgery.
  • Analysis of bowel movement patterns, soiling, constipation, and urinary incontinence stratified by ARM subtype and sacral status.

    • Main Results:

    • 74.3% of patients achieved voluntary bowel movements, with rates varying significantly by diagnosis (100% for rectal atresia/perineal fistula to 15.8% for bladder-neck fistula).
    • Total continence (voluntary bowel movements without soiling) was achieved in 40.8% of cases, with higher rates in simpler defects.
    • Constipation affected 43.1%, and urinary incontinence was noted in 19% of cloaca patients (higher with longer common channels) and those with sacral anomalies.

    Conclusions:

    • The posterior sagittal approach yields variable functional outcomes in anorectal malformations, highly dependent on the specific diagnosis.
    • Accurate diagnosis and sacral evaluation are crucial for establishing functional prognosis in pediatric patients with ARMs.
    • Timely medical management of functional disorders is essential to enhance the quality of life for affected children.