The distal resection of the rectal pouch in laparoscopic-assisted anorectoplasty for high-and intermediate anorectal malformation: 153 cases’ experience in a single center

Abstract Background and purpose The neuromuscular defects in the distal 2-3cm of the rectal pouch has be confirmed in many histopathological studies. This study aimed to evaluate the factors associated with constipation and the efficacy of the distal 3cm resection in males with high-and intermediate anorectal malformation (ARM). Methods Demographic, associated anomalies, clinical features, and the bowel function of the males with ARM and rectourethral/rectovesical fistula (RUF/RVF) were evaluated. The Krickenbeck scores were used to assess bowel function. Univariate and multivariate analysis were used to identify factors associated with constipation. The bowel function was evaluated between the resected group (DRL of not less than 3cm) and control group after 1:1 propensity score matching (PSM). Result A total of 153 males with a median follow-up period of 6 years, 54(35.2%) suffered from constipation. Multivariate analysis revealed that the DRL (OR = 0.68, P = 0.007) is the only independent protective factor of constipation after potty training. After PSM, 45 patients were included in resected group and control group, and the patients were well-balanced. No significant differences between groups were noted in postoperative complications (20.0% vs. 15.7% P = 0.581) and constant soiling (11.1% vs. 15.7%, P = 0.979). However, the incidence of constipation in the resected group was significantly lower than that in the control group (46.7% vs. 71.1%, P = 0.050). Conclusion The longer distal resection was the independent protective factor for constipation in males with high-and intermediate ARM, suggesting that the excessive preservation of the rectal pouch is the cause of constipation. And the constipation rate in ARM with distal 3 cm resection was significantly lower without increment of soiling after PSM. Thus, males with high-and intermediate ARM benefit from the distal 3cm resection based on the current evidence, and the precise length also need to be considered in combination with imaging and pathological data.