POSTERIOR SAGITTAL ANORECTOPLASTY - FUNCTIONAL RESULTS OF PRIMARY ANDSECONDARY OPERATIONS IN COMPARISON TO THE PULL-THROUGH METHOD IN ANORECTAL-MALFORMATIONS

Background: Control of defaecation after surgical correction of high a nd intermediate types of congenital anorectal malformations is difficu lt. The posterior sagittal approach with careful reconstruction of the external sphincter is postulated to give a better outcome than the pu ll-through operation. The functional results of these procedures perfo rmed in one centre were evaluated in order to identify prognostic fact ors. Material and methods: Between 1979 and 1992 66 patients with high or intermediate congenital anorectal anomalies were treated in our ce ntre. In 16 patients a pull-through operation (Kiesewetter-Rehbein) wa s performed. After 1984, the posterior sagittal anorectoplasty (PSARP) (Pena and de Vries) was used in 35 patients as the primary operation. In 22 patients a PSARP operation was done as a secondary procedure, i n one third of these patients after a previous pull-through operation in our centre. The functional results were analysed in retrospect. Res ults: Sixty operations in 53 patients could be evaluated. The overall continence rate was 34 %. After the pull-through operation six out of 15 patients (40 %) were continent, after a primary PSARP 10 out of 25 (40 %) and after a secondary PSARP operation five out of 20 patients ( 25%). Patients with a sacral defect were continent only in 16 % as com pared to 44% of the patients with a normal sacrum. Sex was also releva nt: 67 % of the girls were continent, compared to 30 % of the bogs. Te n out of 11 girls (90 %) with a normal sacrum became continent. Conclu sion: The PSARP for high and intermediate anorectal malformations does not give better functional results than the pull-through operation. T he prognosis is determined by other factors than the type of operation , notably sex and the presence or absence of sacral defects.