Introduction: Anorectal malformation (ARM) is a birth defect of the digestive tract in which the anus and rectum are not normally developed. Surgical procedure such as colostomy (loop or divided) is suggested as the initial treatment for high variety ARM. Our objective was to compare frequency of stoma related complications of loop sigmoid colostomy versus divided sigmoid colostomy for high variety anorectal malformations. Materials and Methods: A randomized controlled trial was carried out at children’ s hospital and the institute of child health Lahore. A total of 180 patients were divided into two groups randomly using lottery method loop sigmoid colostomy (group-A) and divided sigmoid colostomy (group-B). After surgeries patients were followed weekly up till 4 weeks. Stoma related complications were noted. Results: The mean age in group A and group B were 3. 22 ± 1. 26 days and 3. 36 ± 0. 97 days respectively. In group A there were 77 male & 13 were female, in group B there were 67 male & 23 female patients. In group A 24. 5% patients had complications: 3. 4% patients had retraction, 11. 1% had prolapse, 2. 2% had Obstruction, parastomal hernia was seen in 5. 6%, stoma necrosis were seen in 2. 2%. In group B 20% patients had different complications: 2. 2% patients had retraction, 2. 2% had prolapse, 5. 6% had obstruction, parastomal hernia were seen in 2. 2% and stoma necrosis were seen in 7. 8%. The complications in group A were higher when compared to group B but were not significant, p-value > 0. 05. Conclusion: Divided sigmoid colostomy can be adopted to avoid stoma related complications in future.

The purpose of this study is to investigate the age –related improvement of defecation function in high type anorectal malformation in relation to the assessment of the internal anal sphincter. The function of defecation was studied every 5 years up to 15 years postoperatively according to the Japanese scoring system in our hospital in 50 patients operated for high type (recto-urethral fistula) imperforate anus with posterior sagital anorectoplasty (PSARP) procedure in 25 patients, and 25patients with endorectal pull-through (ERPT). The internal anal sphincter was assessed by anorectal manometry and histology, and the results were analyzed with the clinical outcomes. The defecation scores of the PSARP cases exceeded those of ERPT cases at all age groups, the averaged total score were 7.0 in the PSARP cases vs. 4.6 for ERPT cases at 5 years old, 7.5 vs. 5.2 at 10 years old, and 8.0 vs. 6.7 at 15 years old. The anorectal reflex was seen in 17 of 25 (68%) PSARP cases examined, whereas seen in 5 (20%) of ERPT cases examined. Histologically, the welldeveloped and thickened internal circular muscle at the rectal end was found only in 40% of the cases, whereas discontinuation and hypoplasty of the muscle were seen in most of the cases examined. The present results indicate that the internal sphincter muscle at the rectal end may be histologically maldeveloped in high type anorectal malformations; however, they can potentially develop after transplanted and contribute to the improvement of passive continence in the late post-operative period.

Introduction: Anorectal malformation [ARM] can be treated either by staged procedures or by a single stage procedure. In the present study we have performed single stage surgery of ARM in male neonates. Materials and Methods: Retrospective review of cases of ARM operated over 4 years at Indira Gandhi Institute of Medical Sciences, Patna, and Bihar from January 2015 to December 2018 were undertaken. In this study we have compared the results of single stage repair of Anorectal malformation with that of staged procedures performed earlier. Fifty four patients of Anorectal malformation were operated by single stage procedure (category 1) this was compared with staged procedures (category 2). Forty three patients underwent primary PSARP (posterior sagittal anorectoplasty) and the remaining 11 primary APP (abdomino-perineal pull through) procedure. The result of these single stage procedures were compared with that of staged procedures (category 2) in which a total of 39 cases were operated from 2012 to 2014. Result: Mean post-operative hospital stay in category 1 was 11 days and 32 days in category 2. In category 1, 20 patients were analysed. In which PSARP procedure was done in 15 and in 5 patients APP procedure was performed. The Rest of the patients are in follow up. Kelly score was good to fair in 17 patients (85%) and poor in 3 (15%) patients. In category 2 it was good to fair in 28 (71. 7%) cases and poor in 11 cases (28%). Conclusion: Single stage surgical repair of anorectal malformation in male neonates is reliable and can be safely performed. Early results are encouraging; however, a long term follow-up is required to get any definite conclusion.

Introduction: Assessment of the sacral ratio (SR) in patients with an anorectal malformation (ARM) compared to normal children and verifying whether it has a predictive value for fecal incontinence.Materials and Methods: From January 2006 to December 2007, 51 patients (£11 years) with an ARM which having been operated upon were assessed. Meanwhile 252 normal individuals with the matched age and sex were enrolled in this study. Patients (up to 30 years) who were passing solid or paste-like stools but no soiling were deemed continent and those with no sphincter control were deemed incontinent. Pelvic radiographic images were obtained in the AP and lateral position. The SR was calculated in all patients and normal individuals. The SR was calculated on AP and lateral views by drawing 3 parallel horizontal lines through the superior portion of the iliac crest, through the inferior part of sacroiliac joints and through the top of the coccyx (A, Band C lines respectively). The SR=BC/AB.Results: Of the total 51 patients, 27 were continent and 24 were incontinent. In the incontinent patients group (n=24) the AP SR<0.54 was obtained, but in the contient patients group (n=27) the AP SR>0.54 in contrast to the control group 30 individuals had AP SR<<0.54 and 222 subjects had AP SR>0.54.Conclusion: The patients group had a significantly lower AP and lat SR than normal subjects. 3AP and Lat SR were significantly predicted incontinence ariance.

Background and Objectives: Optimal surgical management of the neonate with imperforate anus depends on accurate determination of the level of the rectal pouch. The use of ultrasound to determine the pouch level has been previously described, but has not become widely accepted. The goal of this study is to determine the validity of this measurement according to final surgical findings in patients with anorectal malformation. Materials and Methods: In a cross sectional study,23 children with imperfo-rated anus were evaluated by transperineal ultrasound with a 7.5 MHz sector transducer in the supine and lithotomic positions to determine the pouch level and pouch to perineum (P-P) distance. In all cases, the level of the distal pouch was confirmed by definitive surgery or distal colostogram. The agreement between sonography and surgery or colostogram as gold standard was obtained by weighted kappa test. Results: In five children, the pouch to perineum (P-P) distance was less than 10mm. All of these low lesions were safely treated by a simple perineal anoplasty (minimal posterior sagittal anorectoplasty; i.e. minimal PSARP) and were confirmed as low type. Seven children had P-P distance of 10-15 mm. In the follow up definitive surgery, 5 cases were intermediate and two cases were high. Eleven children had a P-P distance of more than 15 mm, of which ten cases were high lesions and had colostomy at birth. During follow up, 8 cases underwent definitive surgery of PSARP and two of these high cases were confirmed by distal colostogram and one case was categorized as intermediate by definitive PSARP. Measure of agreement (Kappa) was calculated to be 0.791 (P = 0.001) Therefore, Ultrasound correctly predicted the level of the distal pouch in 20 of 23 patients.Conclusion: Transperineal ultrasound can be confidently used prior to surgical decision in children with imperforate anus in addition to physical exam.

Introduction: Mild anterior displacement of the anus may be a cause of constipation. Routinely for detection of the anterior anus, the mean anal position index is used but in this study we introduce another modality for this purpose.Material and Methods: In this prospective study, patients with intractable constipation with onset bellow one year of age, normal rectal manometry, normal rectal biopsy and abnormal shape of anal verge, were include. The location of the anus was checked by muscle stimulator and according to the severity of the anteriority mini anorectoplasty or simpleY-V transposition of the anus was performed.Results: Ten patients were studied. All were female with a mean age of 7 months. In 2 cases anorectoplasty and in the others Y-V anoplasty was done. All patients ultimately were cured.Conclusion: Using muscle stimulator in external sphincter is reliable for detection of anterior displacement of the anus. Anorectoplasty or Y-V anoplasty for resolving constipation in these patients are effective.