APPRAISAL OF THE CLINICAL OUTCOME AND ANORECTAL FUNCTION AFTER POSTERIOR SAGITTAL ANORECTOPLASTY FOR HIGH ANORECTAL MALFORMATIONS: A PROSPECTIVE COMPARATIVE STUDY OF ONESTAGE VS. MULTISTAGE PROCEDURE.

Background: PSARP procedure is claimed to have a better chance of enabling normal continence in later years. 
Questions have arisen regarding whether PSARP is superior to other repair methods. 
Objective: This study was designed to analyze quantitatively the clinical, manometric and functional results of PSARP and to compare the results of one stage PSARP with the multistage PSARP. 
Patients: A prospective study of eighty patients with high anorectal malformation who were selected out of 193 cases 
admitted in the period from June 1997 to March 2000 to the Main Alexandria University Hospital. 
Methods: Twenty patients were selected at random for the one-stage PSARP (Group I). Multistage PSARP were carried out for the remaining sixty patients (Group II). All patients were assessed by electrostimulation, MRI, manometry, and FCS. 
Prospective follow up recorded the efficacy of PSARP, the clinical and the functional outcome together with complications. 
All patients were followed up for a period that ranged from three years to six years with a mean of 4.52 ± 0.63 years. 
Results: Electrostimulation revealed that in only 49 patients (61.25%), the new anal site was found to be central within the muscle complex. 43.75% were continent with good FCS. 28.75% were intermittently continent. 27.5% had involuntary passage of stools at least once a day. One stage operation resulted in a much more superior FCS than the multistage procedure with highly significant difference in the good FCS and poor FCS cases. RAP was < 40 cm H2O in patients complaining of soiling. 
All continent patients showed MSP > 135 cm H2O. There was no clear correlation between RV and soiling, but patients with severe soiling had an RV > 150 mL. 76.25% showed a rectal sensation “urge to go”. 36.25% showed a normal RAIR. Results of MRI correlated well with FCS and electrostimulation. Eleven patients had postoperative complications. 
Conclusion: PSARP allows preservation of the anatomy of pelvic floor muscles and limits affection of fecal continence. One stage PSARP is a safe effective procedure which gives the superior results in treatment of patients with high Anorectal malformations. It minimizes postoperative complications, colostomy drawbacks, costs, hospital stay and psychological problems.