Long-Term Functional Outcomes of an Anorectal Malformation French National Cohort

Abstract

Objectives: The present study aimed to assess long-term functional outcomes of children with anorectal malformations (ARMs) across a network of expert centers in France. Methods: Retrospective cross-sectional study of patients ages 6–30 years that had been surgically treated for ARM. Patient and ARM characteristics (eg, level, surgical approach) and functional outcomes were assessed in the different age groups. Results: Among 367 patients, there were 155 females (42.2%) and 212 males (57.8%), 188 (51.2%) cases with, and 179 (48.8%) higher forms without, perineal fistula. Univariate and multivariate statistical analyses with logistic regression showed correlation between the level of the rectal blind pouch and voluntary bowel movements (odds ratio [OR] ¼ 1.84 [1.31– 2.57], P < 0.001), or soiling (OR ¼ 1.72 [1.31–2.25], P < 0.001), which was also associated with the inability to discriminate between stool and gas (OR ¼ 2.45 [1.28–4.67], P ¼ 0.007) and the presence of constipation (OR ¼ 2.97 [1.74–5.08], P < 0.001). Risk factors for constipation were sacral abnormalities [OR ¼ 2.26 [1.23–4.25], P ¼ 0.01) and surgical procedures without an abdominal approach (OR ¼ 2.98 [1.29–6.87], P ¼ 0.01). Only the holding of voluntary bowel movements and soiling rates improved with age. Conclusion: This cross-sectional study confirms a strong association between anatomical status and functional outcomes in patients surgically treated for ARM. It specifically highlights the need for long-term follow-up of all patients to help them with supportive care.