Outcomes of modified posterior sagittal anorectoplasty with internal sphincter preservation in the treatment of intermediate anorectal malformations in children

Objective: This study aimed to evaluate the long-term outcomes of modified posterior sagittal anorectoplasty (PSARP) with internal sphincter preservation for the treatment of intermediate anorectal malformations (ARM) in children. Methods: A total of 41 medical records of pediatric patients who were diagnosed with intermediate ARMs according to the Wingspread classification at the National Children's Hospital from February 2014 to December 2015 were reviewed. The collected data included general information, intraoperative and postoperative outcomes, and early and long-term complications. Results: The study showed that 28 (68.3%) achieved good bowel function, 11 (26.8%) had moderate bowel function, and only two (4.8%) had poor bowel function. Constipation was observed in 6 patients (14.6%), ranging from grade I to grade II, with all cases responding to dietary changes and/or laxatives. Most patients did not experience fecal incontinence or only had occasional incontinence (78.1%), with only 4.8% experiencing frequent incontinence. All children had normal urinary function, and all boys had morning erections. Conclusion: Modified PSARP with preservation of the sphincter in the treatment of intermediate-type ARM in children provides favorable long-term outcomes with good bowel function, excellent bowel control, and minimal complications.