Quality of Life of Children with Anorectal and other Associated Malformations

Background: Incidence of anorectal malformation was 1 of 5000 livebirth new-born, 64% suffered of associated malformations. Surgical reconstruction was performed in early childhood and complications like incontinence and constipation affected long term outcome. Aim was to evaluate the quality of life and complications after surgical reconstruction. We hypothesized that they had disadvantages in daily life and worthier quality of life in spite of adequate pediatric surgical treatment with correct anatomical reconstruction.

Methods: Between 2004 and 2014 forty-four children with anorectal malformation were treated at university hospital. 65,8% had associated malformations. Used surgical technique was posterior sagittal anorectal plasty. We analyzed pre- and postsurgical development, recorded quality of life and clinical outcome with questionnaires.

Results: Parents specified common quality of life averages with 83,2%, their children with 90,1% of 100% via questionnaires. Parents of children with associated cardio vascular disease estimated with 81,7%, with associated urological diseases 82,7% and with associated genital diseases 83,2%. In case of vertebral or spinal associated malformation parents evaluated an average of quality of life with 84,6%. In children with caudal regression syndrome parents specified 82,8%, the children themselves with 93,1%. Physical well-being in children with associated malformations was estimated with 83,7% by parents, in children with isolated anorectal malformation we found 77,7%. Psychological well- being war scored with 90,2% in children with associated malformations, and with 84,4% in children with isolated anorectal malformation. The results for self-esteem was higher without associated malformations (84,7%), than in children with associated malformations (74,6%).

Conclusion: Postsurgical outcome of anorectal malformations was good independently of associated malformations. None of these patients had a significant limitation for quality of life. The sub score of self-esteem was lower in those patients and because of these findings psychological support should be added to pediatric standard examinations. Sensitization of parents and surgeons is necessary.