Primary Repair of High and Intermediate Anorectal Malformations in the Neonates

Background/Purpose: The standard treatment of high and intermediate anorectal malformation (ARM) is the staged approach. A growing interest in one- stage correction of ARM was noted recently. The aim of this study was to examine the feasibility, safety, and short-term outcome of primary repair of high and intermediate ARM in neonates. Materials and Methods: This prospective study included 38 full-term infants (22 females and 16 males) with either high (n=9) or intermediate (n= 29) ARM treated during a 6- year period. All patients underwent posterior sagittal anorectoplasty (PSARP) without colostomy. The exclusion criteria included: prematurity, associated major congenital anomalies, bad general condition, persistent cloaca in females and unfavorable circumstances. Preoperative imaging using ultrasonography and magnetic resonance imaging (MRI) was performed to assess the severity of ARM and any associated anomalies. All patients were evaluated as regard to operative details, postoperative complications, and bowel function on short and long-term follow up, which ranged from 2 to 62 months. Results: All patients were treated entirely through the posterior sagittal approach except one male patient with rectovesical fistula, who required laparotomy. Intraoperative complications included: opening the posterior wall of the vagina (n=6), injury of the seminal vesicle (n=1). Postoperative complications included: wound infection in 9 patients, one of them required colostomy and 2 required secondary sutures. Postoperative anal stenosis occurred in five patients, all treated with anal dilatation. Twenty-five patients defecate spontaneously, 9 require oral medication or rectal stimulation or enemas occasionally, and three are maintained on bowel program. Eight of the 10 females older than 3 years of age are continent, while only 5 of the 8 male patients older than 3 years are continent with infrequent soiling. One patient had anesthetic complications and died 5 days after surgery. Conclusion: 1. One-stage repair of intermediate and high ARM both in male and female neonates is technically feasible; 2. The safety of this approach depends on adherence to strict inclusion criteria; 3. The early postoperative complications are acceptable and can be managed successfully; 4. The functional results are comparable to those reported in patients undergone the standard staged technique.