Long-term functional outcome and quality of life in patients with high imperforate anus Mohamed S. Hashish a , Hamada H. Dawoud b , Ronald B. Hirschl a , Steven W. Bruch a , Akram M. El Batarny b , George B. Mychaliska a , Robert A. Drongowski a , Peter F. Ehrlich a , Sayed Z. Hassaballa b , Nagi I. El-Dosuky b , Daniel H. Teitelbaum a, ⁎ a Section of Pediatric Surgery, Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA b Pediatric Surgery Unit, Department of Surgery, Tanta University, Tanta, Egypt Received 5 October 2009; accepted 6 October 2009 Key words: Imperforate anus; Incontinence; Constipation; Quality of life; Anorectal malformation Abstract Purpose: Anorectal malformations (ARMs) are associated with a large number of functional sequale that may affect a child's long-term quality of life (QOL). The purposes of this study were to better quantify patient functional stooling outcome and to identify how these outcomes related to the QOL in patients with high imperforate anus. Methods: Forty-eight patients from 2 children's hospitals underwent scoring of stooling after 4 years of life. Scoring consisted of a 13-item questionnaire to assess long-term stooling habits (score range: 0-30, worst to best). These results were then correlated with a QOL survey as judged by a parent or guardian. Result: Mean (SD) age at survey was 6.5 (1.6) years. Comparison of QOL and clinical scoring showed no signficant difference between the 2 institutions (P N .05). There was a direct correlation between the QOL and stooling score (Pearson r 2 = 0.827; β coefficient = 24.7, P b .001). Interestingly, functional stooling scores worsened with increasing age (Pearson r 2 = 0.318, P = .02). Patients with associated congenital anomalies had a high rate of poor QOL (44% in poor range; P = .001). Stooling scores decreased significantly with increasing severity/complexity of the ARM (P = .001). Conclusion: A large number of children experience functional stooling problems, and these were directly associated with poor QOL. In contrast to previous perceptions, our study showed that stooling patterns are perceived to worsen with age. This suggests that children with ARMs need long-term follow-up and counseling. © 2010 Elsevier Inc. All rights reserved. Anorectal malformations (ARMs) comprise a wide spectrum of clinical presentations. These malformations range from minor easily treated defects that have an excellent functional prognosis to complex defects that are difficult to manage [1-3]. Although surgical advances have been made [4], fecal incontinence and constipation remain major postoperative complications that impede social and psycho- logic development in patients with high imperforate anus Presented at the 40th Annual Meeting of the American Pediatric Surgical Association, Fajardo, Puerto Rico, May 28-June 1, 2009. ⁎ Corresponding author. Section of Pediatric Surgery, University of Michigan Hospitals, Box 0245, Ann Arbor, Michigan 48109. Tel.: +1 734 936 8464; fax: +1 734 936 9784. E-mail address: dttlbm@umich.edu (D.H. Teitelbaum). www.elsevier.com/locate/jpedsurg 0022-3468/$ – see front matter © 2010 Elsevier Inc. All rights reserved. doi:10.1016/j.jpedsurg.2009.10.041 Journal of Pediatric Surgery (2010) 45, 224–230