Comparison of clinical outcomes and anorectal manometry in patients with congenital anorectal malformations treated with posterior sagittal anorectoplasty and laparoscopically assisted anorectal pull through.

PURPOSE: The objective of this study is to analyze the clinical outcomes and anorectal manometry (AM) in infants with congenital high anorectal malformations treated with posterior sagittal anorectoplasty (PSARP) and laparoscopically assisted anorectal pull through (LAARP).

MATERIALS AND METHODS: From August 2005 to December 2008, 23 patients with congenital high anorectal malformations were randomly distributed into PSARP and LAARP groups. All of them underwent LAARP (11 cases) or PSARP (12 cases) at 2 or 3 months old. Clinical outcomes and results of anorectal manometry were compared between patients at the age of 17.4 +/- 4.9 and 19.3 +/- 6.2 months (P = .4270), respectively.

RESULTS: Kelly's clinical score for patients in LAARP and PSARP groups was 3.91 +/- 1.14 and 3.83 +/- 1.40 (P = .8827), respectively. Anal canal resting pressure and high-pressure zone length were 29.4 +/- 7.2 vs 23.4 +/- 6.5 mm Hg (P = .0479) and 14.9 +/- 3.0 vs 13.9 +/- 3.1 mm (P = .4414), respectively. Rectal anal inhibitory reflex was observed in 81.8% (9/11) and 83.3% (10/12) patients (P = 1.0000), respectively. The mean length of stay during the second hospitalization was 10.6 +/- 0.9 and 14.3 +/- 1.4 days (P < .0001), respectively.

CONCLUSIONS: Although no significant difference can be noted in clinical scoring between both groups, the results of anorectal manometry indicate that LAARP can significantly improve anal canal resting pressure and reduce the length of stay.