Pediatric Surgery International

, Volume 25, Issue 10, pp 863–868 | Cite as

Prospective long-term functional and cosmetic results of ASARP versus PASRP in treatment of intermediate anorectal malformations in girls

  • Sherif M. K. ShehataEmail author
Original Article



Prospective randomized comparison of the functional and cosmetic results of anterior sagittal anorectoplasty (ASARP) and posterior sagittal anorectoplasty (PSARP) in the management of intermediate anorectal malformations (ARMs) in girls was performed.


Thirty-eight girls with intermediate ARMs were randomly allocated to group A treated by ASARP technique and group B treated by PSARP technique: 14 girls from each group passed 30-month age for early functional assessment by Templeton and Holschneider scores, 18 cases passed 55 months for late functional evaluation. Results were compared statistically where P value ≤ 0.05 was considered significant.


Cosmetic satisfaction was higher in ASARP group with a median score of 3 compared to 2 in PSARP group. Functional results were assessed early at median of 33.5 months post-repair where Templeton score was 4 versus 3.75 and Holschneider score was 11 versus 11. Late functional assessment was done for 8 cases from each group where Templeton score was 4 versus 4, while Holschneider score was 12 versus 11.


ASARP is an optimal technique for treatment of intermediate ARM in girls. Cosmetic results were superior to PSARP. Despite the observations that functional results give higher scores in ASARP group versus PSARP group, no statistical significance could be reached.


Vestibular fistula excision Anorectal malformations ASARP PASRP Vestibular anus Functional results 


  1. 1.
    Spouge D, Baird PA (1986) Imperforate anus in 700,000 consecutive live born infants. Am J Med Genet 2(Suppl):151–161Google Scholar
  2. 2.
    Holschneider A, Huston J, Peña A, Beket E, Chatterjee S, Coran A, Davies M, Georgeson K, Grosfeld J, Gupta D, Iwai N, Kluth D, Martucciello G, Moore S, Rintala R, Smith ED, Sripathi DV, Stephens D, Sen S, Ure B, Grasshoff S, Boemers T, Murphy F, Soylet Y, Dubbers M, Kunst M (2005) Preliminary report on the international conference for the development of standards for the treatment of anorectal malformations. J Pediatr Surg 40:1521–1526PubMedCrossRefGoogle Scholar
  3. 3.
    Peña A (1995) Anorectal malformations. Semin Pediatr Surg 4:35–47PubMedGoogle Scholar
  4. 4.
    De Vries PA, Peña A (1982) Posterior sagittal anorectoplasty. J Pediatr Surg 17:638–643CrossRefGoogle Scholar
  5. 5.
    Tsuji H, Okada A, Nakai H, Azuma T, Yagi M, Kubota A (2002) Follow-up studies of anorectal malformations after posterior sagittal anorectoplasty. J Pediatr Surg 37:1529–1533PubMedCrossRefGoogle Scholar
  6. 6.
    Rintala R, Lindahl H (1995) Is normal bowel function possible after repair of intermediate and high anorectal malformation? J Pediatr Surg 30:491–494PubMedCrossRefGoogle Scholar
  7. 7.
    Javid PJ, Barnhart DC, Hirschl RB, Coran AG, Harmon CM (1998) Immediate and long term results of surgical management of low imperforate anus in girls. J Pediatr Surg 33:198–203PubMedCrossRefGoogle Scholar
  8. 8.
    Goon H (1990) Repair of anorectal anomalies in the neonatal period. Pediatr Surg Int 5:246–249CrossRefGoogle Scholar
  9. 9.
    Liu G, Yuan J, Geng J, Wang C, Li T (2004) The treatment of high and intermediate anorectal malformations: one stage or three procedures? J Pediatr Surg 39:1466–1471PubMedCrossRefGoogle Scholar
  10. 10.
    Laberge JM (1997) The anterior sagittal approach to the treatment of anorectal malformations: evolution of Mollard approach. Semin Pediatr Surg 6:196–203PubMedGoogle Scholar
  11. 11.
    Peña A (1988) Posterior sagittal anorectoplasty: results in the management of 332 cases of anorectal malformations. Pediatr Surg Int 3:94–104Google Scholar
  12. 12.
    Ong N, Bealsey SW (1990) Comparison of clinical methods for the assessment of continence after repair of high anorectal anomalies. Pediatr Surg Int 5:233–237Google Scholar
  13. 13.
    Rintala RJ (1998) Anorectal malformations: an overview. In: Stringer MD, Oldham KT, Mouriquand PDE, Howard ER (eds) Pediatric surgery and urology: long term outcomes, 1st edn. Saunders, Philadelphia, pp 357–375Google Scholar
  14. 14.
    Zamir N, Mirza FM, Akhtar J, Ahmed S (2008) Anterior sagittal approach for anorectal malformations in female children: early results. J Coll Physicians Surg Pak 18:763–767PubMedGoogle Scholar
  15. 15.
    Kaddah SN (2007) One stage repair of intermediate and high anorectal malformations in newborn. Ann Pediatr Surg 3:144–149Google Scholar
  16. 16.
    Okada A, Kamata S, Imura K, Fukuzawa M, Kubota A, Yagi M, Azuma T, Tsuji H (1992) Anterior sagittal anorectoplasty for rectovestibular and anovestibular fistula. J Pediatr Surg 27:85–88PubMedCrossRefGoogle Scholar
  17. 17.
    Kumar B, Kandpal DK, Sharma SB, Agrawal LD, Jhamariya VN (2008) Single stage repair of vestibular and perineal fistulae without colostomy. J Pediatr Surg 43:1848–1852PubMedCrossRefGoogle Scholar
  18. 18.
    Menon P, Rao KL (2007) Primary anorectoplasty in females with common anorectal malformations without colostomy. J Pediatr Surg 42:1103–1106PubMedCrossRefGoogle Scholar
  19. 19.
    Aziz MA, Banu T, Prasad R, Khan AR (2006) Primary anterior sagittal anorectoplasty for rectovestibular fistula. Asian J Surg 29:22–24PubMedGoogle Scholar
  20. 20.
    Levitt MA, Peña A (2006) Operative management of anomalies in females. In: Holschneider AM, Huston JM (eds) Anorectal malformations in children: embryology, diagnosis, surgical treatment, follow-up, 1st edn. Springer, Berlin, pp 303–307Google Scholar
  21. 21.
    Wakhlu A, Pandey A, Prasad A, Kureel SN, Tandon RK, Wakhlu AK (1996) Anterior sagittal anorectoplasty for anorectal malformations and perineal trauma in the female child. J Pediatr Surg 31:1236–1240PubMedCrossRefGoogle Scholar
  22. 22.
    Heinen FL (1997) The surgical treatment of low anal defects and vestibular fistulas. Semin Pediatr Surg 6:204–216PubMedGoogle Scholar
  23. 23.
    Kulshrestha S, Kulshrestha M, Singh B, Sarkar B, Chandra M, Gangopadhyay AN (2007) Anterior sagittal anorectoplasty for anovestibular fistula. Pediatr Surg Int 23:1191–1197PubMedCrossRefGoogle Scholar
  24. 24.
    Peña A, Hong A (2000) Advances in the management of anorectal malformations. Am J Surg 180:370–376PubMedCrossRefGoogle Scholar
  25. 25.
    Holschneider AM, Koebke J, Meier-Ruge W, Land N, Jesch NK, Pfrommer W (2001) Pathophysiology of chronic constipation in anorectal malformations. Long term results and preliminary anatomical investigations. Eur J Pediatr Surg 11:305–310PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  1. 1.Section of Pediatric Surgery, Department of SurgeryTanta UniversityTantaEgypt
  2. 2.TantaEgypt

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