Repair of anorectal anomalies in the neonatal period

In a 3-year period between 1986 and 1988, 147 patients with anorectal anomalies were seen in our department; 93 were neonates, of which 35 had low malformations treated by anoplasty soon after birth. Fifty-eight had high and intermediate types; 26 of these had defunctioning colostomies. One of the 26 patients had the definitive repair done in the neonatal period, the other 32 were operated on with posterior sagittal anorectoplasty (PSARP) as a one-stage procedure in the neonatal period. The majority (85%) were operated on within 4 days of birth. There was no operative mortality. The commonest complication was wound infection, which was mild in 15 patients and severe in 2. There were no anal strictures. The functional results were good in 30 and average in 3 patients. A comparison with 60 older children who had a similar operation done as a staged procedure in the same period showed equally low morbidity and good functional results. Based on these results, it was found that one-stage repair of high and intermediate types of anorectal anomalies in the neonate using PSARP is safe and feasible.