The long-term post-surgical outcome of intermediate anorectal malformation in our department
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In brief
In brief
This retrospective study evaluates long-term bowel function outcomes in 11 patients with intermediate anorectal malformations treated with a continence-preserving pull-through procedure, showing favorable results with 9% incontinence and 45% constipation rates after median 14.4-year follow-up. The study compares these outcomes with historical literature and emphasizes the importance of preserving continence mechanisms during surgical repair.
- Pull-through procedures preserving continence mechanisms achieved 91% continence rate at 14+ years follow-up in intermediate ARM patients.
- Constipation remains common (45%) despite good surgical outcomes, requiring long-term bowel management strategies.
- Preservation of rectal angulation and rectoanal inhibitory reflex correlates with favorable continence outcomes post-anorectoplasty.
- Fistula recurrence occurred in 18% of cases, necessitating surgical revision and extended surveillance protocols.
- Outcome variability across anorectoplasty techniques highlights need for standardized long-term assessment tools in ARM surgery.
Written by the GCMD Library team from the article.
Abstract
Background
Posterior sagittal anorectoplasty and laparoscopic-assisted anorectal pull-through are preferred for anorectal malformation (ARM) today, while careful pull-through procedures with sacroperineal approach yield excellent outcomes. This study focuses on a pull-through procedure emphasizing continence mechanism preservation and compares outcomes with historical studies with various procedures.
Methods
Bowel function of patients with intermediate ARM followed up for over 10 years post-surgically was assessed. Data collected included ARM type with the Krickenbeck classification, comorbidities, complications, post-surgical examinations, follow-up, and bowel function at the latest clinic visit. The literature review collected original articles including more than 10 post-anorectoplasty cases which were followed for over 10 years.
Results
Eleven cases were identified, with a median age at anorectoplasty and follow-up length of 6.9 months and 14.4 years. Two fistula recurrences required surgical treatment. Long-term incontinence and constipation were observed in 9% and 45% of the cohort, respectively. Good rectal angulation and a positive rectoanal inhibitory reflex were confirmed in most cases examined. A literature review identified eight studies with various outcome-measuring instruments.
Conclusion
Outcomes of the introduced pull-through procedure were favorable, while the literature review highlights the variation in outcomes of various anorectoplasty.
Evidence Level
Level IV.