0944 Manifestations of congenital anorectal malformations in adulthood

One of the underlying themes of this series of extracts from the literature is the importance of outcomes and long-term follow up of early interventions. Previous summaries have referred to the relative lack of data on health economics of paediatric interventions and quality of life of survivors, and comment has been made on the limited follow-up of surgical interventions, with much of the focus having been on correction, survival and follow-up to discharge from hospital. Long-term follow-up is mainly compromised by the discontinuity of care as patients progress from neonatologists and neonatal surgeons to paediatric specialists and then to providers of adolescent and adult care. A recent UK-based follow-up of 225 patients with congenital anorectal malformations (ARMs) highlights the problem. The condition, that is said to affect between 1 in 3500 to 5000 live births, is associated with high survival rates and expectations of reaching adulthood. Reports have focused on outcomes in early childhood, and the overall tone is one of optimism. In the study under consideration, successful contact was made with 114, and 74 returned questionnaires that covered bowel and bladder function, body esteem, sexual function, and general health/quality of life. While it is acknowledged that results might be biased (problems more likely to be reported; patients from tertiary or quaternary hospital populations), respondents reported high levels of urinary and bowel incontinence, with high ARMs more likely in such patients. Body esteem scores were lower than normal for both men and women, as were sexual wellbeing and quality of life.

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