Anorectoplasty for Anorectal Malformations: Surgical Outcomes, Predictive Factors for Continence and Quality of Life

Anorectal malformations (ARMs) are a heterogeneous group of congenital anomalies involving abnormal development of the distal rectum and anus, frequently accompanied by fistulous connections and associated urogenital or spinal defects. Despite major advances in pediatric colorectal surgery, achieving satisfactory long-term outcomes remains challenging, particularly in relation to fecal continence, postoperative complications, and psychosocial well-being. This review aimed to synthesize recent evidence on the surgical outcomes of anorectoplasty techniques, the predictive factors associated with postoperative continence, and the long-term impact of treatment on quality of life. A narrative review approach was adopted. Literature was searched across PubMed, ScienceDirect, and Dimensions AI, focusing on studies published between 2021 and 2025. Following screening and eligibility assessment, 13 studies were included in the final synthesis. Evidence from the reviewed studies indicates that posterior sagittal anorectoplasty (PSARP) remains the standard surgical technique for many ARM subtypes because of its strong anatomical visualization and broad applicability. Minimally invasive approaches, including laparoscopic-assisted anorectoplasty (LAARP) and robotic-assisted anorectoplasty (RAARP), appear promising, particularly in selected complex cases, with potential advantages such as reduced postoperative pain, shorter recovery time, improved cosmetic outcomes, and enhanced operative precision. However, long-term evidence for these newer techniques remains limited. Across the included studies, continence outcomes were influenced by multiple factors, including age at surgery, malformation type, sacral development, sphincter integrity, and associated anomalies. High-type malformations were consistently associated with less favorable functional outcomes than low-type malformations. In addition, quality of life after repair was shaped not only by continence status and bowel function but also by psychosocial adjustment, stigma, and access to multidisciplinary follow-up care. Overall, the findings highlight the importance of early intervention, individualized surgical planning, structured long-term bowel management, and coordinated multidisciplinary care. Further multicenter prospective studies are needed to strengthen comparative evidence and improve lifelong outcomes for patients with anorectal malformations.