Fifteen years of experience in the treatment of anorectal malformations.
OBJECTIVE
To analyze our experience in the treatment of anorectal malformations (ARM) with the posterior sagittal anorectoplasty (PSARP), and our modifications through the last few years and the outcomes.


METHODS
We reviewed 107 cases divided into two groups: Former (F: 1994-2003) and Recent (R: 2004-2008). Type of ARM, associated anomalies, management and complications were noted. A telephone questionnaire regarding continence outcome was addressed to the 74 cases older than 3 years.


RESULTS
According to the type of ARM, there were 53 perineal fistulas, 2 anal stenoses, 11 no fistulas, 12 rectourethral fistulas (5 rectobulbar and 7 rectoprostatic fistulas), 22 vestibular fistulas, 1 rectovesical fistulas and 6 cloacas. A total of 47 patients presented with 73 associated malformations. As much as 45 colostomies were performed, including 5 perineal fístulas, with 6 of 7 vestibular fístulas in group F and only 8 of 15 in group R. We had 19 complications of PSARP. The most frequent one was rectal mucosa prolapse in 14 (12F and 2R) and 2 wound infections (F). Continence was good in 62, poor in 3 and fair in 5. Seven out of eight children with poor or fair continence had associated malformations.


CONCLUSIONS
All perineal fístulas can be managed without colostomy. Vestibular fístulas can be safely treated without colostomy in otherwise healthy patients without severe malformations. Overall, continence is good, and fair/poor results are related to associated malformations. Cumulative experience helps avoid colostomies and reduce complication and reoperation rates.
Julià
Victoria
V
Paediatric Surgery Department, Hospital Sant Joan de Déu-Clínic, University of Barcelona, Espluges de Llobregat, Barcelona, Spain. vjulia@hsjdbcn.org
Tarrado
Xavier
X
Prat
Jordi
J
Saura
Laura
L
Montaner
Albert
A
Castañón
Montserrrat
M
Ribó
Josep Maria
JM
D001003:Anal Canal / Q000002:abnormalities* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003125:Colostomy / Q000379:methods*; D003248:Constipation / Q000209:etiology / Q000601:surgery; D004065:Digestive System Abnormalities / Q000150:complications / Q000601:surgery*; D005242:Fecal Incontinence / Q000209:etiology / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D012007:Rectum / Q000002:abnormalities* / Q000601:surgery; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome