title: Posterior sagittal anorectoplasty results in better bowel function and quality of life in adulthood than pull-through procedures.
abstract: OBJECTIVE
  The short-term outcome of posterior sagittal anorectoplasty (PSARP) procedure has been reported to be better than after abdominoperineal or abdominosacroperineal (AP) procedures. This study aimed to investigate the long-term functional outcome and quality of life after PSARP in adulthood and compare with the outcome after AP procedures.
  
  
  METHODS
  Twenty-four patients operated with PSARP at the Department of Pediatric Surgery, Uppsala, Sweden, from 1984 to 1993 were identified. They were compared with 20 patients that underwent AP pull-through procedures from 1974 to 1983. The patients were sent validated bowel function and quality of life (SF-36) questionnaires. Sixteen PSARP (median age 21, five females) patients and fourteen AP patients (seven abdominosacroperineal and seven abdominoperineal pull-throughs, median age 32, seven females) responded and were included in the study.
  
  
  RESULTS
  The median Miller incontinence score was 1 (range 0-13) in the PSARP group and 10 (range 3-16) in the pull-through group (P=0.0042). The use of underwear protection and oral loperamide was significantly less frequent in the PSARP group (P=0.0096 and 0.0021 respectively). The SF-36 scores of Vitality, Mental health and Mental Cluster Scale were higher in the PSARP group (P=0.0291, 0.0500, 0.0421 respectively).
  
  
  CONCLUSIONS
  PSARP results in superior bowel function and better quality of life in adulthood compared with AP procedures for the repair of anorectal malformations.
authors.affiliation: Institution of Surgical sciences, Uppsala University, Uppsala, Sweden; Institution of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Pediatric Surgery, Akademiska Sjukhuset, Uppsala, Sweden. Electronic address: johan.danielsson@akademiska.se.
authors.forename: Johan
authors.initials: J
authors.lastname: Danielson
authors.affiliation: Institution of Surgical sciences, Uppsala University, Uppsala, Sweden; Department of Surgery, Akademiska Sjukhuset, Uppsala, Sweden.
authors.forename: Urban
authors.initials: U
authors.lastname: Karlbom
authors.affiliation: Institution of Surgical sciences, Uppsala University, Uppsala, Sweden; Department of Surgery, Akademiska Sjukhuset, Uppsala, Sweden.
authors.forename: Wilhelm
authors.initials: W
authors.lastname: Graf
authors.affiliation: Department of Pediatric Surgery, Akademiska Sjukhuset, Uppsala, Sweden.
authors.forename: Leif
authors.initials: L
authors.lastname: Olsen
authors.affiliation: Department of Pediatric Surgery, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden.
authors.forename: Tomas
authors.initials: T
authors.lastname: Wester
mesh_terms: D000293:Adolescent; D000328:Adult; D001003:Anal Canal / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000503:physiopathology / Q000601:surgery*; D003672:Defecation / Q000502:physiology*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012007:Rectum / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D011795:Surveys and Questionnaires; D013548:Sweden; D055815:Young Adult
keywords: Anorectal malformation; Functional outcome; Posterior sagittal anorectoplasty; Quality of life