Outcome of Surgical Correction of Anorectal Malformations

Anorectal malformations are common congenital disorders that need proper programmed management, hoping to reach the most accepted functional results. The main functional post operative complications were incontinence and constipation. Incontinence represents the main complication after correction of high anomalies while constipation is much more common in low anomalies. Three stage procedures to high and intermediate anomalies have best functional results as regard bowel control. Low anomaly managed by anoplasty or limited PSARP must followed by regular dilatation programs to avoid possibility of stenosis and megarectum. Evaluation of ability of bowel control not less than three years or even more. This study revealed that There is no significant differences among the studied group as regard age in functional outcome .However increasing age carry more improvement in bowel control. In all submitted patient no urinary incontinence at all, which may be explained by posterior sagittal approach and prohibited combined abdominal perineal approach. Neonatal colostomy in high anomalies with subsequent definitive surgery has better functional results than one stage PSAR; in spite some authors recommend one stage. High anomalies infants suffer from defective bowel control (incontinence) more than low anomalies. Low anomalies infants showed small percentage suffering incontinence, which most of them due to initial progressive constipation resulting in megarectum with soiling and constipation. Clinical assessment based mainly on history and examination based on scoring system has been the most common method to evaluate functional outcome. The outcome has usually been presented as good, fair, or poor. Infants with poor functional results must be re investigated to exclude incorrect surgical intervention, if so, redo surgery must prepared. Strict follow up and periodic evaluation is the gold method to achieve the best possible results e.g.: dilatation program after anorectal reconstruction is protection against anal stenosis with subsequent constipation and megarectum.