Secondary posterior sagittal anorectoplasty for anorectal malformations

Abstract

Sixteen patients who had undergone secondary posterior sagittal anorectoplasty (PSARP) for fecal incontinence were clinically followed for 3 to 10 years (mean 5.8). In addition to preoperative manometric evaluation, postoperative anorectal manometry was performed on all patients 1–3 times. Fourteen of the 16 patients underwent postoperative biofeedback training. At the last follow-up visit, the mean age of the patients was 18.3 years (range 16–26). Fectal continence improved in 13 patients. Manometrically measured, both the squeeze and resting pressures in the anal canal were significantly increased. Biofeedback facilitated the improvement of continence in 10 of the 14 patients. However, at the last follow-up, only 4 had good fecal continence with voluntary bowel movements and only occasional soiling. Three patients had voluntary bowel movements but frequent soiling; 8 used daily enemas to stay clean and 1 has a permanent colostomy. Secondary PSARP improves fecal continence in patients with intractable incontinence following primary repair of anorectal anomalies, but in adulthood it is good in only a minority of cases. Most patients require adjunctive measures to maintain socially acceptable bowel function.