Do low-type anorectal malformations have a better prognosis than the intermediate and high types? A preliminary report using the Krickenbeck score

Background: Following the development of the Wingspread classification for anorectal malformations, low-type lesions were considered to have a better functional prognosis than intermediate and high lesions. This study rejects this basic presumption following the establishment of the latest standards at Krickenbeck in May 2005. Patients and Methods: The surgical approach, whether perineal (group A) or posterior sagittal anorectoplasty (group B), was determined depending on the presence or absence of a perineal fistula. Group C consisted of patients below the age of three years. Sacral anomalies were screened by lumbosacral radiography. Information on postoperative anorectal function (voluntary bowel movements, soiling, and constipation) was gathered by phone call. Results: Eight of the 9 patients in group A, and 2 of the 7 in group B achieved voluntary bowel movements (p < 0.05). No significant differences were found between the two groups with respect to either the occurrence or severity of soiling and constipation. All subjects in group C (n = 4) had fewer than 3 daily stools with total cleanness between episodes but still suffered from constipation. Conclusions: Basic ideas about anorectal malformations will continue to be modified when the criteria are changed. The use of the Krickenbeck score will help to standardize the results of studies.