Chulalongkorn Medical Journal


Background: Anorectal malformations (ARMs) represent a wide spectrum of disease with various operative managements. Posterior sagittal anorectoplasty (PSARP) has been developed as the standard technique. However, there are still controversies in the management of ARMs.Objectives: The objective of this study was to assess the operative managements including associated anomalies and functional outcome of anorectal malformations at King Chulalongkorn Memorial Hospital over a 13-years.Methods: A retrospective study was conducted at King Chulalongkorn Memorial Hospital between January 2004 and December 2016. Patients’ information was classified based on Krickenbeck classification. Statistical analysis was performed using IBM SPSS statics 22.0 version for MAC.Results: A total of 96 patients underwent repair of ARMs. The most common ARMs in male patients were rectourethral fistulas (32.0%) and in female patients were vestibular fistulas (45.0%). Seventy-five (78.0%) patients had at least one associated anomaly. Thirty-four patients (36.0%) had VACTERL association. There were 74 (77.0%) patients were managed with colostomy as staged procedures. All patients with rectourethral bulbar fistulas underwent PSARP (11/11) while patients with rectourethral prostatic fistulas or rectovesical fistulas underwent abdominoperineal pull-through (12/17), PSARP with laparotomy (4/17) and PSARP (1/17). ARMs with perineal fistulas underwent cut back operation (7/13), PSARP (3/13) and ASARP (3/13) depending on surgeons’ preferences. ARMs with vestibular fistulas underwent PSARP (15/21) or ASARP (6/21). Mostly cloacal malformations underwent PSARVUP with laparotomy (6/13). ARMs with no fistula underwent PSARP (13/13). H-type ARMs underwent fistulectomy (4/5) and ASARP with protective colostomy (1/5). Fifty-three patients (61.0%) had no postoperative complications. Continence was achieved in 80.0% of the patients. The median time of follow up is 4.5 years.Conclusion: In our series, the incidences of ARMs according to Krickenbeck classification are quite similar compared to other studies. Operative managements of ARMs are highly variable depending on types of ARMs. Functional outcome is also comparable to other studies.


Faculty of Medicine, Chulalongkorn University

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