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
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References
- One-stage correction of high imperforate anus in the male neonate.J Pediatr Surg. 1999; 34: 834-836
- Advantages of performing the sagittal anoplasty operation for imperforate anus at birth.J Pediatr Surg. 1990; 25: 276-277
- Repair of anorectal anomalies in the neonatal period.Pediatr Surg Int. 1990; 5: 246-249
- Classification, identification and assessment of surgical treatment of anorectal anomalies.Pediatr Surg Int. 1986; 1: 200-205
- Clinical outcome and long-term quality of life after surgical correction of Hirschsprung’s disease.J Pediatr Surg. 1996; 31: 1496-1502
- Advances in the management of anorectal malformation.Am J Surg. 2000; 180: 370-376
- 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
- Is normal bowel function possible after repair of intermediate and high anorectal malformation?.J Pediatr Surg. 1995; 30: 491-494
Peña A: Imperforate anus and cloacal malformations, in Ashcraft KW (ed): Pediatric Surgery. Philadelphia, PA, Saunders, pp 473-492
- Colostomy for anorectal anomalies.J Pediatr Surg. 2001; 36: 795-798
- Colostomy complications in infants and children.Ann R Coll Surg Engl. 1996; 78: 526-530
Article info
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Copyright
© 2004 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
