title: Posterior sagittal anorectoplasty: functional results of primary and secondary operations in comparison to the pull-through method in anorectal malformations.
abstract: BACKGROUND
  Control of defaecation after surgical correction of high and intermediate types of congenital anorectal malformations is difficult. The posterior sagittal approach with careful reconstruction of the external sphincter is postulated to give a better outcome than the pull-through operation. The functional results of these procedures performed in one centre were evaluated in order to identify prognostic factors.
  
  
  METHODS
  Between 1979 and 1992 66 patients with high or intermediate congenital anorectal anomalies were treated in our centre. In 16 patients a pull-through operation (Kĩesewetter-Rehbein) was performed. After 1984, the posterior sagittal anorectoplasty (PSARP) (Peña and deVries) was used in 35 patients as the primary operation. In 22 patients a PSARP operation was done as a secondary procedure, in one third of these patients after a previous pull-through operation in our centre. The functional results were analysed in retrospect.
  
  
  RESULTS
  Sixty operations in 53 patients could be evaluated. The overall continence rate was 34%. After the pull-through operation six out of 15 patients (40%) were continent, after a primary PSARP 10 out of 25 (40%) and after a secondary PSARP operation five out of 20 patients (25%). Patients with a sacral defect were continent only in 16% as compared to 44% of the patients with a normal sacrum. Sex was also relevant: 67% of the girls were continent, compared to 30% of the boys. Ten out of 11 girls (90%) with a normal sacrum became continent.
  
  
  CONCLUSIONS
  The PSARP for high and intermediate anorectal malformations does not give better functional results than the pull-through operation. The prognosis is determined by other factors than the type of operation, notably sex and the presence or absence of sacral defects.
authors.affiliation: Paediatric Surgical Centre, Amsterdam, The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Mulder
authors.forename: E
authors.initials: E
authors.lastname: de Jong
authors.forename: I
authors.initials: I
authors.lastname: Wauters
authors.forename: M
authors.initials: M
authors.lastname: Kinders
authors.forename: H A
authors.initials: HA
authors.lastname: Heij
authors.forename: A
authors.initials: A
authors.lastname: Vos
mesh_terms: D001003:Anal Canal / Q000503:physiopathology / Q000601:surgery*; D000714:Anastomosis, Surgical / Q000379:methods*; D001006:Anus, Imperforate / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005242:Fecal Incontinence / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000503:physiopathology* / Q000601:surgery; D011379:Prognosis; D012003:Rectal Fistula / Q000151:congenital* / Q000503:physiopathology / Q000601:surgery; D012007:Rectum / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D016896:Treatment Outcome