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Vol 10, No 1 (2008)
Published online: 2008-04-15

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Results of surgical correction of anorectal malformations in children - 16-years experience

Jerzy Niedzielski
Chirurgia Polska 2008;10(1):16-29.


Introduction: The aim of this study was functional and manometric evaluation of the results of surgical treatment of children with anorectal malformations (ARM) via posterior sagittal approach.
Material and methods: Between 1992 and 2008, 94 children (50 girls and 44 boys) with ARM underwent posterior sagittal anorectoplasty (PSARP) by Peña. In all operated children duration of pregnancy, body weight at birth and Apgar score were analyzed, the type of ARM was determined and sacroiliac ratio (SIR) calculated. All children were assessed functionally (score "10") and manometrically 6 months to 16 years after surgical correction of ARM. The obtained results were compared with those in reference group of 40 children (20 girls and 20 boys) aged 6-16 years, presented with abdominal pain with no disorders of passing stool and urine.
Results: Mean duration of pregnancy in case of children with low defects was 39.4 weeks and did not significantly differ (p > 0.05) from pregnancy duration in children with high defects - 38.8 weeks. Similarly, mean birth body weight of children with low defects - 3037 g did not significantly differ (p > 0.05) from weight of neonates with high defects - 3185 g. Also, Apgar score was similar in both groups of children. The most frequent in the whole group of 94 children was perineal fistula observed in 26 patients (27.6%). Among high defects the most frequent was urethral prostatic fistula - in 9 boys (9.6%) and persistent cloaca in 3 girls (3.2%). Out of 91 patients qualified for PSARP, correction of low defects was done in 68 children (74.7%), while high defects were repaired in 23 children (25.3%). Complications related to all surgical procedures performed in the examined group were observed in 15 patients (15/94-15.9%). According to "10" score of 91 patients after primary correction of ARM the result was considered good in 83 children (91.2%), fair in 5 children (5.5%) and unfair in three patients (3.3%). In the entire studied group mean result in "10" score in patients with high ARM (x = 7.04) was significantly lower (p < 0.001) than that in children with low ARM (x = 9.47). The values of all studied manometric parameters in the group of high defects were significantly lower than mean values in the group of low defects (p < 0.001) as well as in the reference group (p < 0.001). However, mean values of the studied parameters in children with low defects were also lower than those in the reference group (p < 0.001, p < 0.02, p < 0.004), apart from the resting anal pressure (RAP), which value did not differ from that in the reference group (p > 0.05).
Conclusion: Analysis of the results of surgical treatment of children with ARMs performed in this study confirmed high effectiveness of posterior sagittal anorectoplasty - PSARP. Author obtained a good functional result in 91.2% of operated patients which would not be possible with previously used operative techniques.

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