TREATMENT OF ANORECTAL MALFORMATIONS IN BOYS AT THE MODERN STAGE: A LITERATURE REVIEW

Abstract

Anorectal malformations (ARM) in boys represent a heterogeneous spectrum of congenital anomalies affecting 3.0-3.5 per 10,000 live births, ranging from simple perineal fistulas to complex rectovesical communications. Accurate diagnosis relies on comprehensive clinical examination, cross-table lateral radiography, ultrasonography, and magnetic resonance imaging, with systematic classification according to the Krickenbeck system guiding therapeutic decisions. Associated anomalies occur in 48-78% of cases, predominantly affecting genitourinary (40%) and spinal (25-34%) systems, necessitating multidisciplinary evaluation. Surgical management strategies have evolved significantly, with posterior sagittal anorectoplasty (PSARP) remaining the gold standard while laparoscopic-assisted anorectoplasty (LAARP) offers a minimally invasive alternative with comparable functional outcomes. The choice between single-stage and staged repair depends on malformation complexity, patient anatomy, and institutional expertise. Postoperative complications include anal stricture (6-50%), rectal prolapse (14-30%), and urological complications, particularly in high-type malformations. Functional outcomes demonstrate voluntary bowel movements in 53-62% of patients, with fecal incontinence affecting 42-48% and constipation in 67%. Long-term quality of life is significantly impacted by continence status, emphasizing the importance of comprehensive bowel management programs and lifelong multidisciplinary follow-up for optimal outcomes