Long-Term Outcomes in Children Operated for Anorectal Malformations: Which factors influence the quality of life?

M Mezni¹, Y Ben Ahmed¹, A Jouini¹, M Marzouki¹, F Nouira¹, S Jlidi²

¹Children Hospital Bechir Hamza, Pediatric surgery department B. Tunis, Tunisia
²Department of pediatric surgery B, children Hospital Bechir Hamza, Tunis, Tunisia

Background
Anorectal malformations (ARMs) are rare congenital anomalies requiring early surgical correction. In recent years, long-term outcomes, particularly bowel function and quality of life, have become critical components of patient care. This study aimed to assess functional outcomes following ARM repair and identify factors influencing the quality of life.

Methods
We conducted a retrospective single-center study including children operated on for ARMs between January 2011 and December 2021. All patients were aged over 3 years at last follow-up. Fecal continence was evaluated using the Krickenbeck classification. Data on ARM subtype, associated anomalies, and school performance (via parent interviews) were collected.

Results
Thirty patients were included (21 males, 9 females; mean age: 8.5 years [range 3–13]).

• Voluntary bowel movements were observed in 76.7% of cases.
• Soiling was present in 73.3%, ranging from occasional to severe with social impairment.
• Constipation affected 56.7%, requiring dietary, pharmacologic, or mechanical interventions.
  The mean Krickenbeck continence score was 4.4/7

Children with complex ARMs (high fistulas) had significantly worse continence (p = 0.02). All children with high anorectal malformations required laxatives; nine of them underwent pelvic floor physiotherapy with improvement. Two patients with the poorest continence underwent Malone appendicostomy.

Associated anomalies were present in 56.7% of patients. Sacral anomalies were significantly associated with poorer continence outcomes (p = 0.037).
School difficulties were reported in 40% of school-aged children, including absenteeism, social withdrawal, and reduced academic performance. Poor continence was significantly associated with impaired school integration (p = 0.023).

Conclusion
Despite surgical correction, many children with ARMs continue to experience significant bowel dysfunction. The presence of associated anomalies, particularly sacral defects, and poor continence adversely affect psychosocial development and academic integration. Comprehensive long-term follow-up, individualized bowel management programs, and psychosocial support are essential to optimize functional and quality-of-life outcomes in this population.

Keywords: Anorectal malformation, constipation, soiling, Krickenbeck

M Mezni¹, Y Ben Ahmed¹, A Jouini¹, M Marzouki¹, F Nouira¹, S Jlidi²

¹Children Hospital Bechir Hamza, Pediatric surgery department B. Tunis, Tunisia
²Department of pediatric surgery B, children Hospital Bechir Hamza, Tunis, Tunisia

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