Quality of life and defecative function 10 years of longer after posterior sagittal anorectoplasty and laparoscopic-assisted anorectal pull-through for anorectal malformation

Abstract

Background: In our centre, high-/intermediate-type anorectal malformation has been treated by posterior sagittal anorectoplasty (PSARP) before 2000, and by laparoscopic-assisted anorectal pullthrough (LAARP) thereafter. We would like to compare the quality of life (QOL) and long-term defecative function between these two groups of patients 10 years after reconstructive surgery. Materials and methods: Patients who underwent LAARP between 2001 and 2005 were compared with historical controls treated with PSARP between 1996 and 2000. Degrees of continence were graded by the Krickenbeck classification and Kelly’s score. QOL was assessed by Hirschsprung disease/ Anorectal malformation Quality of Life (HAQL) questionnaire. Results were compared using chi-square test and t-test. Results: There were 14 LAARP and seven PSARP patients. All attained voluntary bowel movements. Moderate to severe soiling (Krickenbeck Grade 2 and 3) was found in 3/14 LAARP (21.4%) and 1/7 PSARP (14.3%) patients, p = 1.00. Constipation requiring use of laxatives was present in 3/14 LAARP (28.6%) and 1/7 PSARP (14.3%) patients, p = 0.62. Mean Kelly’s scores were 3.79 ± 0.98 (LAARP) and 4.71 ± 1.25 (PSARP), p = 0.12. No patient required Malone antegrade continence enema. HAQL scores were comparable in physical functioning, emotional functioning and social well-being between the two groups, and did not appear to correlate with age or gender. However, consistently low scores were demonstrated in the scale of social functioning. Conclusion: The 10-year outcome between LAARP and PSARP patients in terms of QOL and defecative function is comparable. Impairment in social functioning in these patients is reflected by the self-report low level of functioning.