Evaluation Of One-Stage Posterior Sagittal Anorectoplasty For The Repair Of High And Intermediate Anorectal Malformations

Background/Purpose: The traditional surgical correction of high and intermediate anorectal malformations (ARMs) is divided into 3 stages; colostomy, posterior sagittal anorectoplasty (PSARP), and colostomy closure. The last 2 decades witnessed adoption of one-stage correction of ARMs. The aim of this study was to evaluate the feasibility, safety, and short-term outcome of primary repair, using the PSARP, of high and intermediate ARMs in neonates.Materials & Methods: A total of 38 patients (24 females and 14 males) with either high (n=7) or intermediate (n=31) ARMs treated during a 4-year period. All patients underwent standard PSARP without colostomy. The exclusion criteria included: prematurity, associated major congenital anomalies, bad general condition, and persistent cloaca in females. Patients were evaluated as regard to operative details, postoperative complications, and bowel function. Follow up period ranged from 6 to 39 months.Results: Twenty three patients showed delayed presentation. The procedure could be completed entirely through a posterior sagittal approach; only one patient required a laparotomy to divide a high rectovesical fistula. Intraoperative complications included: posterior vaginal wall tears (n=4), injury of the prostate (n=2), rectal wall tear (n=1) and diathermy burn (n=1). Perioperative mortality was 0. Postoperative complications included: superficial wound infection in 7 patients, deep infection in 3 girls 2 of them required colostomy and 1 required a redo. Postoperative anal stenosis (n=4), all treated with anal dilatation. Mucosal prolapse (n=5). Of 22 (>2.5 yrs), 7 patients showed incontinence (true; n=4, stress/diarrhea; n=3). Nine pts had variable grades of soiling. Thirteen patients had variable grades of constipation.Conclusions: 1. One-stage repair of high and intermediate ARMs is technically feasible; 2. The approach is safe provided adherence to strict exclusion criteria with optimum operative and postoperative conditions; 3. The early postoperative complications are acceptable and can be managed successfully; 4. The functional outcome is comparable to that of the standard staged technique.