RESUMEN
The malformations of the anorectum are common congenital anomalies. The usual treatment of high anorectal malformations is creating a colostomy at birth, posterior sagittal anorectoplasty [PSARP] at 9-12 months of age and closure of colostomy 4 - 6 weeks later after regular anal dilatation. This 'delayed PSARP' has a number of disadvantages including poor development of normal defecation reflexes. To evaluate continence, cost of management and duration of hospitalization with primary PSARP and to compare it with delayed PSARP. This prospective study was done at the Department of Pediatric Surgery, Children Hospital, Lahore from Nov 1999 to No v 2001. Twenty-four infants [19 boys, 05 girls] with high anorectal malformation were included in the study. All had well developed sacrum and natal cleft, and weighed more than 3 Kg. Twelve patients underwent primary PSARP [Group A] and 12 underwent colostomy, PSARP and then colostomy closure as a three stage procedure [Group B]. The incidence of urinary tract infections [75%], distal loop fecal impaction [41.7%] peri-colostomy skin excoriation [41.7%] was high in Group B as compared to those in Group A. The rate of post PSARP complications and hospital stay was longer in Group B and the average cost including operative procedures, hospital admissions for each complication and follow-up was high [Rs 14,670 +/- 400] in Group B. These results suggest that one stage PSARP is a safe and viable approach to the management of high anorectal malformations in a selected group of neonates