Posterior sagittal anorectoplasty: Results in the management of 332 cases of anorectal,malformations

This is a retrospective evaluation of the functional results obtained in 332 patients who underwent posterior sagittal anorectoplasty (PSARP) for the treatment of an anorectal malformation. All patients were operated on by the same person between September 1980 and June 1987. One hundred sixty-one patients were excluded: younger than 3 years, mentally retarded, colostomy still open, deaths, lost to follow-up, and having complex malformations. Patients were grouped according to their potential for continence. Voluntary bowel movements were considered one of the best indicators of fecal continence and were found among patients with a normal sacrum in 77% of those with rectourethral fistula and 30% of those with a vesical fistula. Except in 1 case, all patients with a normal sacrum and low malformation, vestibular fistula, anorectal agenesis without fistula, persistent cloaca, and atresia or stenosis had voluntary bowel movements. Different degress of soiling were present in patients with a normal sacrum including 20% with vestibular fistula, 30% with no fistula, 25% with atresia or stenosis, 61% with rectourethral fistula, 75% with cloacas, 50% with vesical fistulae, and 0% low malformations. Different degrees of constipation were found in patients with a normal sacrum including 50% with low malformations, 70% with vestibular fistulae, 55% with no fistula, 25% with atresia or stenosis, 30% with urethral fistulae, 75% with cloacas, and 50% with vesical fistulae. In contrast, only 20% of patients with more than 3 sacral vertebrae missing achieved voluntary bowel movements; 60% suffered constant soiling, 20% constipation, and 60% urinary incontinence. All evaluations were done without medical management. The average age of patients with voluntary bowel movements was 4.5 years; for patients without voluntary bowel movements it was 4 years. Patients with a normal sacrum and fecal incontinence operated upon elsewhere underwent secondary PSARP, achieving marked improvement in 45% of cases, some improvement in 37%, and no improvement in 18%. In contrast, those with an abnormal sacrum achieved 20%, 30%, and 50% respectively in each of the above-mentioned categories.