Continuing problems in patients who undergo repair for anorectal malformation

As the number of long-term survivors after the repair of anorectal malformations increases, continuing problems affecting the quality of adult life are receiving greater attention in the field of pediatric surgery. Many studies concluded that completely normal defecation could not be achieved after surgical repair of high-type anomalies, even though function improved with age. Reports of the long-term outcomes of surgical procedures to restore anal sphincter function, such as gracilis muscle transplantation, remained limited. Urinary complications such as neurogenic bladder are frequently observed in adulthood among patients born with anorectal malformations. Urinary and fecal incontinence disrupt job performance and other social activities in most patients. In addition, a fairly high incidence of retrograde ejaculation and abnormal penile erection causing female infertility has been reported recently, although successful management of pregnancy and delivery was reported in selected cases. Interdisciplinary medical support is necessary to treat these problems in adulthood after the repair of anorectal malformations and should be established as a future goal.