Assessment and comparison of fecal continence in children following primary posterior sagittal anorectoplasty and abdominoperineal pull through for anorectal anomaly using clinical scoring and MRI

IntroductionWe aimed to compare and contrast these main surgical procedures for ARM in terms of structural outcome through pelvic MRI & functional outcome through Kelly's scoring.Material and methodA prospective study was conducted from August 2011 to July 2013 including all the cases of ARM managed in single stage (operated by one surgeon, first author) since 1995 that came for follow up at age of 3 years or more. Patients were divided in three groups: Group 8.A, PSARP (60 patients); Group B, Abdomino-PSARP (40 patients); and Group C, APPT (40 patients). The functional assessment of anal continence was carried out at the age of 3 years or more using Kelly's method. Structural assessment was done by 1.5-T Magnetic Resonance Imaging (MRI).ResultsIn 24 patients with rectobulbar fistula, 71.5% of Group A patients had good continence. In 50 patients with rectoprostatic fistula, 73.7% of Group A, 70% of group B and only 36% of Group C had good outcomes. Better development of each muscle was associated with better outcomes in terms of anal continence (P = 0.001).ConclusionThere is better outcome with PSARP and Abdomino-PSARP in patients with rectobulbar and rectoprostatic fistula. MRI is a valuable modality for postoperative structural analysis of patients with ARM and is also useful for predicting the long term functional outcome of these cases