Functional outcome in correction of perineal fistula in boys with anoplasty versus posterior sagittal anorectoplasty

Abstract

Optimal surgical therapy for low anorectal anomalies remains controversial. We compared functional outcome after correction of perineal fistula in boys with either anoplasty (AP) or limited posterior sagittal anorectoplasty (PSARP). Thirty-nine boys from two centres treated for perineal fistula with either AP (n = 24) or PSARP (n = 15) from 1996 to 2001 underwent prospective follow-up for functional outcome. In order to minimize heterogeneity of the study groups, only boys with perineal fistula were included. Functional outcome was assessed using a validated bowel function score (maximum score 20). Day and night time wetting as well as the age at potty training were also recorded. An independent nurse specialist interviewed caregivers. AP and PSARP groups were comparable regarding age, associated malformations and frequency of sacral dysplasia. No significant differences between the groups were observed in the overall median bowel function score, AP 18 (11-20) versus PSARP 18 (11-20), or in the age at potty training, AP 32 (14-66) versus PSARP 36 (18-60). Covering colostomy was employed significantly (P < 0.05) more often with PSARP (10/15) than with AP (1/24). Surgery for local complications was carried out significantly (P < 0.05) more often after PSARP (5/15) than after AP (2/24). Two patients in both groups required a temporary salvage colostomy. Overall functional outcome is comparable after AP and PSARP for perineal fistula in boys. As a more straightforward procedure AP is safer and less prone to complications avoiding the need for covering colostomy.