Surgical and Pediatric Manaegement of Anal Atresia: A Single-Center Case Series

INTRODUCTION: Anorectal malformations (ARM), including anal atresia, represent a heterogeneous group of congenital anomalies with variable anatomy, frequent associated malformations, and long-term functional consequences. Despite advances in surgical techniques such as posterior sagittal anorectoplasty (PSARP), functional outcomes remain influenced by malformation type and associated anomalies. This study aimed to evaluate the surgical and pediatric management outcomes of patients with ARM in a single-center experience.
METHODS: This retrospective single-center study included patients diagnosed with anal atresia and treated between January 2015 and January 2026. Demographic data, associated anomalies, Krickenbeck classification, surgical approaches, and early and late outcomes were analyzed. Patients underwent systematic evaluation, including echocardiography, renal ultrasonography, and spinal imaging when indicated. Statistical analysis was performed using appropriate parametric and non-parametric tests.
RESULTS: A total of 52 patients were included; 57.7% were male. Associated anomalies were present in 53.8% of patients. High-type malformations were most common (40.4%). Fistulas were detected in 73.1% of cases. Primary repair was performed in 32.7%, and staged surgery in 67.3%. PSARP was the most frequently used definitive procedure (88.5%). Early postoperative complications occurred in 17.3% of patients. Good continence was achieved in 65.4%, while 11.5% had significant incontinence. Functional outcomes were significantly associated with malformation type and spinal anomalies (p<0.05).
DISCUSSION AND CONCLUSION: PSARP-based surgical management of ARM is safe and effective with acceptable functional outcomes. However, high-type malformations and associated spinal anomalies negatively affect continence. Multidisciplinary management and structured long-term follow-up are essential for optimal outcomes.

Keywords: Anorectal Malformation, Anal Atresia, PSARP, Pediatric Surgery, Continence, Krickenbeck Classification