The Results of Posterior Sagittal Anorectoplasty in Anorectal Malformations

Background: Posterior sagittal anorectoplasty (PSARP) is the newest and most-widely-used technique for correction of anorectal malformations (ARMs). In the present investigation, the functional outcomes of PSARP and also the relationship between the complications and the sacral ratio (SR) have been studied. Methods: The study group included 49 patients (25 males and 24 females) with ARMs, operated on by the PSARP technique during 1995 – 1999. The patients had been followed up for at least 4 years. Those with mental retardation were not included in this retrospective study. For objective evaluation of the sacrum, the SR was calculated in all of the patients. Results: In the female patients, rectovestibular fistula (46%) and in the males, perineal fistula and imperforate anus without fistula, each with equal frequency (28%) were the most common anomalies. The mean SR in the study group was 0.72 + 0.04. SR was 0.67 + 0.03 among patients who had associated urogenital anomalies, 0.69 + 0.04 in patients suffering from soiling, and 0.67 + 0.02 in patients who had postoperative fecal incontinence. The most common complication following PSARP was soiling (44.9%) and then constipation and fecal incontinence in order of frequency. None of the cases developed urinary incontinence or other urinary complications after PSARP. Seventy-three percent of the patients had voluntary bowel movements (VBMs) and 51% were totally continent. Conclusion: Although the PSARP has a negligible complication rate, the success and outcome of the surgical correction in view of the bowel function depend on the development of the sacral nerves. SR reflects the sacral bone development and can be easily calculated by a pelvic AP film. Considering the lower SR in patients suffering from postoperative soling and fecal incontinence, in comparison to the normal group (0.77), SR could be used as a prognostic index to predict the probability of achieving total continence following PSARP.