Functional outcome in patients with anorectal malformation with recto-prostatic or recto-bulbar urethral fistula and comparison between different surgical approaches - a multi-center study [Oral presentation]

Abstract

<p><strong>Purpose: </strong></p><p>To analyze the functional outcome in patients with anorectal malformation with recto-prostatic or recto-bulbar urethral fistula and compare between laparoscopic-assisted anorectoplasty (LAARP) versus posterior sagittal anorectoplasty (PSARP) in a multi-center study. </p><p><strong>Method: </strong></p><p>We performed a retrospective review on all males with anorectal malformation (ARM) and recto-prostatic (ARM-RP) or recto-bulbar urethral fistula (ARM-RB) treated in five tertiary paediatric surgical centres in Hong Kong, Japan and Helsinki in the past 25 years. Defecative function was assessed using the Krickenbeck classification for postoperative results and Kelly’s score. Functional outcomes between patients with LAARP and PSARP were compared. Statistical analysis was performed using Pearson Chi-Square test, Fisher’s Exact test and Independent Samples t-test, and p < 0.05 was considered statistically significant.</p><p><strong>Results: </strong></p><p>There were a total of 136 males with ARM-RP and ARM-RB for analysis, among which 73 (53.7%) had ARM-RP and 63 (46.3%) had ARM-RB. The median age of the patients analyzed was 9.4 years (range 0.8-24.7 years) and the median age at operation was 0.4 years (0 day to 3.1 years). 57 (41.9%) and 79 patients (58.1%) underwent PSARP and LAARP respectively. 34 patients (25%) had VATER association. 111 (81.6%) and 103 patients (75.7%) had sacral and spinal cord anomalies respectively. 19 patients (13.9%) eventually required Malone’s Antegrade Continence Enema (MACE).</p><p>When analysis was performed individually with chi square test, patients with sacral anomalies had a higher incidence of constipation (p=0.01) and were less likely to achieve voluntary bowel movement (p=0.001); whereas there was no difference in incidence of soiling and urinary continence. In patients with spinal cord anomalies, voluntary bowel movement was less likely to be achieved (p=0.0002), and there were higher incidences of the need of regular enemas (p=0.025) and MACE (p=0.0001).</p><p>For the comparison between PSARP and LAARP, no difference in Kelly scores was identified by independent samples t test (p=0.73). Logistic regression for voluntary bowel movement showed that VATER association (p=0.02) and fistula location (p=0.006) were significant prognostic factors, whereas the operation approach (PSARP or LAARP) was not (p=0.65).</p><p>​​​​​​​<strong>Conclusion: </strong></p><p>VATER association and fistula location were significant prognostic factors for voluntary bowel movement, and there appeared to be no significant difference in functional outcome between PSARP and LAARP.</p>