Determinants of Long-Term Bowel Function and Quality of Life Following PSARP for Anorectal Malformations

Abstract Purpose Anorectal malformations (ARM) are associated with substantial variability in long-term bowel function. Although anatomical severity and associated anomalies are identified determinants of outcome, the influence of surgical timing remains controversial. This study evaluated predictors of long-term bowel function and health-related quality of life following posterior sagittal anorectoplasty (PSARP). Methods A national single-center cross-sectional study included patients with ARM treated by PSARP between 1997 and 2019 and aged ≥ 3 years at follow-up. Functional outcomes were assessed using the Bowel Function Score (BFS), and health-related quality of life using the Pediatric Quality of Life Inventory (PedsQL). Associations between outcomes, surgical timing, ARM subtype, and associated anomalies were assessed using uni- and multivariable analyses. Results Fifty-six patients were included (57% female). Median BFS was 16.0 (IQR 12.8–19.0); 39% achieved normal bowel function (BFS ≥ 18). Constipation and soiling were present in 46% and 57% of patients, respectively. Bowel function differed significantly among ARM subtypes (Kruskal-Wallis H = 17.07, p = 0.004). In multivariable analysis, spinal anomalies were independently associated with lower BFS (β − 5.38, p = 0.009), whereas age at definitive reconstruction was not associated with bowel function (p = 0.286). Better bowel function correlated with higher PedsQL scores (ρ = 0.43, p = 0.002). Conclusion Long-term bowel function after PSARP is primarily determined by anatomical and neurological factors rather than surgical timing. Better bowel function is associated with improved quality of life, supporting long-term multidisciplinary follow-up in patients with ARM.