Fecal continence in patients having undergone posterior sagittal anorectoplasty procedure for a high anorectal malformation improves at adolescence, as constipation disappears

Background/Purpose: Constipation is a major complication in patients who ha ve undergone posterior sagittal anorectoplasty (PSARP) operation for a high anorectal malformation. Overflow incontinence is the main cause of fecal s oiling in these patients. The aim of this study was to outline the natural history of constipation in patients with high anorectal malformations and r elate this to the functional outcome at the end of the patient's growth per iod. Methods: The study group consisted of 22 pubertal or postpubertal patients (median age 15; range, 13 to 25) with high or intermediate anorectal malfor mations repaired by PSARP procedure. The patients have been followed-up sin ce birth. Constipation was defined as a need to use medical treatment or di et to ensure bowel emptying. Continence was classified as follows: grade 1, no soiling in any circumstances; grade 2, staining less than once a week, no fecal accidents; grade 3, staining more than once a week, no fecal accid ents; grade 4, daily soiling or accidents, need for regular enemas, or the antegrade colonic enema procedure. All patients underwent anorectal manomet ry and magnetic resonance imaging of the spine and spinal cord. Results: At the time of the study 2 (9%) of the 22 study group patients had constipation, but 15 (68%) had been constipated before puberty. Eleven pat ients (50%) were fully continent (grade 1) without constipation. Six of tho se had a history of constipation associated soiling. Three patients (14%) h ad occasional staining (grade 2) and no constipation. Two of them had been constipated with significant soiling before the onset of puberty. In the 5 (22%) patients with frequent staining (grade 3) the degree of soiling had d ecreased after the disappearance of constipation. Two of the 3 patients wit h poor outcome (grade 4) require regular enemas for recalcitrant constipati on. Spinal cord anomalies were detected in 4 and abnormal sacrum in 15 pati ents. Of the anorectal manometric parameters, only the force of voluntary s phincter squeeze correlated with the functional result. Conclusion: In the majority of patients who underwent PSARP procedure for h igh anorectal malformation, constipation disappears at adolescence, and thi s is associated with improved fecal continence outcome. J Pediatr Surg 36:1 218-1221. Copyright (C) 2001 by W.B. Saunders Company.