Surgical treatment of anorectal anomalies in children: Experience with 224 patients

Abstract

Anorectal anomalies (ARA) are congenital malformations that are represented by a wide spectrum of defects. This report describes the authors' experience and results of surgical treatment of ARA. The aim of this study was to analyse the functional outcome in patients following standardized surgical treatment of ARA. A total of 224 patients (115 girls and 109 boys) were treated from 1988 to 2015 and the data were analysed. All patients underwent a follow-up by the author. Postoperative anorectal function was evaluated based on the ability to have voluntary bowel movement, soiling and constipation. In cases of faecal incontinence bowel management program was applied. In our series of 224 operated patients 52 (24%) had faecal incontinence. Bowel management program was implemented in those patients, with a success rate of 90,6 % immediately after the treatment started in hospital, with a decrease to 83,7 % at home. In puberty success rate increased to 95%. Malone's antegrade enema procedure (ACE procedure) was done in 9 patients. It was successful in 100% of cases in the first year, with complication rate of 44% afterwards (conduit stenosis and leakage). Bowel management program offers significant benefits to children with faecal incontinence after surgical treatment of ARA. The ACE procedure can be implemented in patients after successful bowel management. Although patients are satisfied with ACE procedure, complications are very common.