One-stage correction of intermediate imperforate anus with modified posterior sagittal anorectoplasty

Objective To evaluate clinical advantages of one-stage posterior sagittal anorectoplasty(PSARP)on neonates with intermediate imperforate anus.Methods Thirty-eight neonates,included 10 with high type and 28 with intermediate type,were referred to Children's Hospital of Fudan University and performed PSARP from Jan 2004 to Dec 2006.Among them,5 were females and 33 were males.Patients were divided into 2 groups as follows:group 1 was one-stage pull-through without colostomy(intermediate types without major anomalies),and group 2 was three-stage pullthrough procedure(high types or intermediate types with multiple anomalies).One-staged modified PSARP was performed in the 1st group.In the 2nd group.the patients underwent transverse colostomy and Pena procedure after 3 to 6 months,and colostomy closure were performed after 2 months.The data including congenital anomalies,fetal ages,birth weight,definite operation time and age,complications,hospital stay and cost were analyzed between these two groups.The patients were followed up,and alkql function scores in them were evaluated.Results Among 38 patients.22 cases had single-stage definite operation(mild cardiac and renal anomalies)and 16 cases had three-stage pullthrough operation(10 cases with high types,and 6 cases with intermedfate types).There was no statistically significant difference of the ages,birth weight and definite operation time and age between the 2 groups(P＞0.05).Early complications in group 1 were intestinal obstruction and intestinal perforation.In group 2,early complications were related to colostomy.and Iate complications were prolapse of anal mucosa and soiling.According to followed-up arial function scores.12 were excellent and 4 were good in group 1 while 5 were excellent,5 were good and 1 was poor in group 2.Average hospital stay was 12.06±0.85 days and cost was 10681.1±1759.5 RMB in group 1,while average hospital stay was 33.85±0.94 days and COSt was 27355.9±1952.0 RMB in group 2.There was statistically difference(P＜0.0001)of total hospital stays and cost between the two groups.Conclusions It is safe and teasible for neonates wath intermediate imperforate anus to undergo one-stage modify PSARP without colostomy. Key words: Neonate, Anus, abnormalities;  Rectum, abnormalities