Prospective controlled long-term follow-up for functional outcome after anoplasty in boys with perineal fistula

Background: Functional outcomes after treatment of low anorectal anomalies remain controversial. To address this, we conducted a controlled, prospective single-center long-term follow-up study of functional outcome in boys treated for perineal fistula with anoplasty. Patients and Methods: Twenty-four consecutive boys treated exclusively for perineal fistula from 1992 to 2001 underwent prospective follow-up after completion of toilet training. All of the patients had identical surgical treatment. Functional outcome was assessed according to a previously validated bowel function score (7 questions, maximum score of 20). Daytime and nighttime wetting, as well as the age at toilet training, were also recorded. Thirty-seven age-matched boys served as healthy controls. An independent nurse specialist interviewed caregivers. Results: Age of the patients (9.1 +/- 2.6 years) and controls (9.0 +/- 2.9 years) were similar. Seven patients (32%) had bowel function scores below the 10th percentile (17.2) of the controls, which was chosen as a lower limit of normality. The overall mean bowel function score was significantly lower (P < 0.01) among the patients (17.9 +/- 1.9) compared with the controls (19.1 +/- 1.2). The difference was attributed mainly to significantly lower scores (0-3) among patients in questions assessing constipation (2.4 +/- 0.8 vs 2.9 +/- 0.3; P < 0.05) and soiling (2.5 +/- 0.5 vs 2.8 +/- 0.4; P = 0.05). Constipation and soiling were significantly more common (P < 0.05) among patients (41% and 55%, respectively) compared with controls (8% and 24%, respectively). Conclusions: Overall long-term bowel function is impaired in one third of boys with perineal fistula. The main reasons for impaired functional outcome are constipation and soiling, which affect as many as half the patients.