Anorectal malformation patients’ outcomes after definitive surgery using Krickenbeck classification: A cross-sectional study

Background: The survival of anorectal malformation (ARM) patients has been improved in the last 10 years because of the improvement in management of neonatal care and surgical approaches for ARM patients. Thus, the current management of ARM patients are focusing on the functional outcomes after definitive surgery. Here, we defined the type of ARM and assessed the functional outcomes, including voluntary bowel movement (VBM), soiling, and constipation, in our patients following definitive surgery using Krickenbeck classification. Methods: We conducted a cross-sectional study to retrospectively review medical records of ARM patients who underwent a definitive surgery at Dr. Sardjito Hospital, Indonesia, from 2011 to 2016. Results: Forty-three ARM patients were ascertained in this study, of whom 30 males and 13 females. Most patients (83.7) were normal birth weight. There were ARM without fistula (41.9), followed by rectourethral fistula (25.5), perineal fistula (18.6), vestibular fistula (9.3), and rectovesical fistula (4.7). The VBM was achived in 53.5 patients, while the soiling and constipation rates were 11.6 and 9.3, respectively. Interestingly, patients with normal birth weight showed higher frequency of VBM than those with low birth weight (OR = 9.4; 95 CI = 1.0�86.9; p = 0.04), while male patients also had better VBM than females (OR = 3.9; 95 CI = 1.0�15.6) which almost reached a significant level (p = 0.09). However, VBM was not affected by ARM type (p = 0.26). Furthermore, there were no significant associations between gender, birth weight, and ARM type with soiling and constipation, with p-values of 1.0, 1.0, and 0.87; and 0.57, 1.0, and 0.94, respectively. Conclusions: Functional outcomes of ARM patients in our hospital are considered relatively good with more than half of children showing VBM and only relatively few patients suffering from soiling and constipation. The frequency of VBM might be associated with birth weight and gender, but not ARM type, while the soiling and constipation did not appear to be correlated with birth weight, gender, nor ARM type. Further multicenter study is necessary to compare our findings with other centers.