Long-term results after surgical correction of anorectal malformations.

Our surgical experience with 101 cases of anorectal malformations during the past 21 years includes staged abdominoperineal rectoplasty in 49 patients, perineoplasty in 35 patients, and permanent colostomy in 2 patients. The observations of this clinical study are especially focused on long-term anal continence. The functional results were assessed clinically on the basis of Kelly's criteria (5), and by manometric and radiologic studies. Fifty-one patients, aged 5-25 years, were personally interviewed and 36 of these 51 had manometric and radiologic studies to evaluate postoperative continence. Patients with low-type lesions were more likely to be continent, while patients with high-type lesions had more problems with continence, because a functional internal sphincter is absent in high-type lesions. However, continent patients with high-type lesions as well as those with low-type lesions characteristically had a marked high-pressure zone in the anal canal and an acute anorectal angulation in the defecogram . On the other hand, in the patients with fair or poor results, neither a high-pressure zone in the anal canal nor marked anorectal angulation was found. These results indicate that achievement of continence in patients with a high-type anomaly treated by abdominoperineal rectoplasty depends upon bringing the terminal bowel down exactly within the sling of the puborectalis and careful dilatation of the new anal canal after the creation of a cosmetically satisfactory anal opening.