Is normal bowel function possible after repair of intermediate and high anorectal malformations?

The bowel function of 46 patients who had undergone internal sphincter-saving posterior sagittal anorectoplasty (PSARP) was evaluated by a questionnaire 3 to 10 years after the closure of the colostomy. The bowel function was assessed by a multivariate scoring method. All patients had also been followed up clinically and manometrically. Seventy healthy children with a similar age and sex distribution were used as controls. Sixteen (35%) patients had bowel function scores that were within the range of the scores of healthy children (mean score of healthy children +/- SD). Another 16 (35%) patients with intermediate scores had a clinically good continence. Fourteen (30%) patients with low scores had a clinically fair or poor functional result; 3 of them required enemas because of severe constipation and 11 used protective aids or had to change underwear frequently because of daily soiling. There was a correlation between a good continence outcome and the presence of a functional internal sphincter and high anorectal resting pressure. Absence of a functional internal sphincter, severe sacral anomalies, and constipation were associated with poor functional results. It is concluded that normal bowel function after internal sphincter-saving PSARP may be expected in a significant proportion of children with high or intermediate anorectal anomalies.