Advertisement

The treatment of high and intermediate anorectal malformations: One stage or three procedures?

  • Guochang Liu
    Correspondence
    Address reprint requests to Guochang Liu, Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, People’s Republic of China
    Affiliations
    Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
    Search for articles by this author
  • Jiyan Yuan
    Affiliations
    Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China
    Search for articles by this author
  • Jinmei Geng
    Affiliations
    Jining Medical College, Jining, Shangdong Province, People’s Republic of China
    Search for articles by this author
  • Chunhua Wang
    Affiliations
    Department of Pediatric Surgery, The First People’s Hospital of Jining, Shangdong Province, People’s Republic of China
    Search for articles by this author
  • Tuanguang Li
    Affiliations
    Department of Pediatric Surgery, The First People’s Hospital of Jining, Shangdong Province, People’s Republic of China
    Search for articles by this author

      Abstract

      Background/Purpose

      The aim of this study was to examine the safety, feasibility, and the long-term outcome of complete 1-stage repair of high and intermediate anorectal malformation using posterior sagittal anorectoplasty (PSARP) in a neonate.

      Methods

      One hundred thirteen patients with high-type and intermediate-type anorectal malformations (ARM) underwent follow-up. Of 113 cases, 48 cases entailed a divided colostomy, definitive operation, and colostomy closure (group I); the other 65 patients underwent 1-stage PSARP (group II). Anorectal function was measured by the modified Wingspread scoring, including “excellent,” “good,” “fair,” and “poor.” In barium enema studies, anorectal angulation was judged as “clear,” “unclear,” and “not present,” and leakage of barium was observed in the meantime. For anorectal manometric studies, anal resting pressure (ARP), anal squeezing pressure (ASP), and positive anorectal reflex (PAR) were measured.

      Results

      In group I, the rate of excellent and good scores was 58.3% (28 of 48). In the barium enema examination, 85.4% (41 of 48) was clear and 14.6%(7 of 48) unclear or not present. The rate of barium leakage was 10.4% (5 of 48). In group II, the rate of excellent and good was 53.8% (35 of 65). Anorectal angulations were clear in 83.1% of patients (54 of 65). Barium leakage happened in 7.69% of patients (5 of 65). Early operative complications occurred in 56.3% (27 of 48) of patients in group I and 29.2% (19 of 65) in group II. The incidence of colostomy complications in group I was 39.6% (19 of 48). Soiling and constipation were the major complications after the PSARP operation. The respective rates of constipation in the 2 groups were 47.9% (23 of 48) and 44.6% (29 of 65), and the respective rates of soiling were 47.9% (23 of 48) and 50.8% (33 of 65). There was no significant difference in the mean ARP between the 2 groups.

      Conclusions

      The 1-stage PSARP procedure in the neonate not only achieves the same long-term outcome as the conventional PSARP procedure but also involves fewer short-term complications. Complete 1-stage repair using the PSARP to treat high-type and intermediate-type anorectal malformations is safe and feasible.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of Pediatric Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Albanese C.
        • Jennings R.
        • Lopoo J.
        • et al.
        One-stage correction of high imperforate anus in the male neonate.
        J Pediatr Surg. 1999; 34: 834-836
        • Moore T.
        Advantages of performing the sagittal anoplasty operation for imperforate anus at birth.
        J Pediatr Surg. 1990; 25: 276-277
        • Goon H.
        Repair of anorectal anomalies in the neonatal period.
        Pediatr Surg Int. 1990; 5: 246-249
        • Stephens F.D.
        • Smith E.D.
        Classification, identification and assessment of surgical treatment of anorectal anomalies.
        Pediatr Surg Int. 1986; 1: 200-205
        • Moore S.W.
        Clinical outcome and long-term quality of life after surgical correction of Hirschsprung’s disease.
        J Pediatr Surg. 1996; 31: 1496-1502
        • Peña A.
        • Hong A.
        Advances in the management of anorectal malformation.
        Am J Surg. 2000; 180: 370-376
        • de Vries P.A.
        Results of treatment and their assessment.
        in: Stephens F.D. Smith E.D. Anorectal malformation in children Up-date 1988. Alan R. Liss, New York, NY1988: 481-500
        • Rintala R.
        • Lindahl H.
        Is normal bowel function possible after repair of intermediate and high anorectal malformation?.
        J Pediatr Surg. 1995; 30: 491-494
      1. Peña A: Imperforate anus and cloacal malformations, in Ashcraft KW (ed): Pediatric Surgery. Philadelphia, PA, Saunders, pp 473-492

        • Patwardhan N.
        • Kiely E.M.
        • Drake D.P.
        • et al.
        Colostomy for anorectal anomalies.
        J Pediatr Surg. 2001; 36: 795-798
        • Nour S.
        • Beck J.
        • Stringer M.D.
        Colostomy complications in infants and children.
        Ann R Coll Surg Engl. 1996; 78: 526-530