IS NORMAL BOWEL FUNCTION POSSIBLE AFTER REPAIR OF INTERMEDIATE AND HIGH ANORECTAL-MALFORMATIONS

The bowel function of 46 patients who had undergone internal sphincter -saving posterior sagittal anorectoplasty (PSARP) was evaluated by a q uestionnaire 3 to 10 years after the closure of the colostomy. The bow el function was assessed by a multivariate scoring method. All patient s had also been followed up clinically and manometrically. Seventy hea lthy children with a similar age and sex distribution were used as con trols. Sixteen (35%) patients had bowel function scores that were with in the range of the scores of healthy children (mean score of healthy children +/- SD). Another 16 (35%) patients with intermediate scores h ad a clinically good continence. Fourteen (30%) patients with low scor es had a clinically fair or poor functional result; 3 of them required enemas because of severe constipation and 11 used protective aids or had to change underwear frequently because of daily soiling. There was a correlation between a good continence outcome and the presence of a functional internal sphincter and high anorectal resting pressure. Ab sence of a functional internal sphincter, severe sacral anomalies, and constipation were associated with poor functional results. It is conc luded that normal bowel function after internal sphincter saving PSARP may be expected in a significant proportion of children with high or intermediate anorectal anomalies.