title: Can we expect a favorable outcome after surgical treatment for an anorectal malformation?
abstract: BACKGROUND
  The aim of this study was to retrospectively review the classification, surgical experience, and the functional outcome of anorectal malformations (ARMs) according the type of ARM.
  
  
  METHODS
  A total of 311 children (M:F=200:111) who underwent surgical treatment for ARM between 1990 and 2011 were reviewed. Functional outcomes were evaluated using the Krickenbeck classification. The mean follow-up period was 112.2 ± 76.7months (range: 36.8-414.9months).
  
  
  RESULTS
  In the male patients, 90 (45%) had perineal fistulas, 60 (30%) had urethral fistulas, and 7 (3.5%) had rectovesical fistulas. There were 17 cases of ARM without a fistula (8.5%), and we could not determine the type of fistula in 26 boys (13%) because of follow-up losses and death. In the female patients, 34 (30.6%) had perineal fistulas, 71 (64%) had rectovestibular fistulas, and 2 (1.8%) had rectovaginal fistulas. Four patients did not have a fistula (3.6%). For 264 patients, we did anoplasty (121 cases), fistula transposition (14 cases), and posterior sagittal anorectoplasty (PSARP, 129 cases). We found that 224 (84.8%) patients showed voluntary bowel movements. The overall rate for constipation was 30.7% and for soiling was 6.5%. The continence outcome was good for 82.2% of children, fair for 2.7%, and poor for 15.2%. For rectovestibular fistulas, constipation was higher in the perineal operation group, but the continence outcome was similar.
  
  
  CONCLUSIONS
  Through a review of 20years' experience, an accurate diagnosis based on the Krickenbeck classification and operations following the principles of PSARP are crucial to achieve a good functional outcome in children with an ARM.
authors.affiliation: Division of Pediatric Surgery, Department of General Surgery, Dong-A University Hospital.
authors.forename: So Hyun
authors.initials: SH
authors.lastname: Nam
authors.affiliation: Department of Pediatric Surgery, University of Ulsan College of Medicine and Asan Medical Center.
authors.forename: Dae Yeon
authors.initials: DY
authors.lastname: Kim
authors.affiliation: Department of Pediatric Surgery, University of Ulsan College of Medicine and Asan Medical Center. Electronic address: sckim@amc.seoul.kr.
authors.forename: Seong Chul
authors.initials: SC
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D001003:Anal Canal / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000503:physiopathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D019651:Plastic Surgery Procedures; D012007:Rectum / Q000002:abnormalities* / Q000503:physiopathology / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Anorectal malformation; Constipation; Continence; Imperforate anus; Posterior sagittal anorectoplasty