الفهرس 
Review of LiteratureOnly 14 pages are availabe for public view
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Abstract
Although ARM can be easily detected in the neonatal period by proper clinical examination after resuscitation, there is still delayed diagnosis. This not only occurred in low-resource countries but also in developed one but with low percentage. This delay is usually associated with more morbidity than early presentation (Turowski et al., 2010).
Anorectal malformation (ARM) represents a wide spectrum of malformations associated with urologic, neurologic, and orthopedic malformations. The outcome from the various corrective measures has improved due to new surgical techniques as well as to a better understanding of the pathology (Fabbro et al., 2011).
This study aimed to study defecation and urinary functional outcome according to timing of correction. Also to assess differences in defecation and urinary functional outcome in cases with delayed presentation of ARM. And to determine changes in the defecation and urinary functions with time.
In present work, we studied 60 pediatric patients with anorectal malformations who referred to Ain Shams pediatric surgery department, Qena pediatric surgery unit. The studied children were divided into two groups. group 1 (early correction) included 30 patients who end all procedures for correction of ARM before the age of 6 months, and group 2 (late correction) included 30 patients who end all procedures for correction of ARM after the age of 6 months.
Before inclusion in the study, all participants gave an informed consent, and the study protocol was approved by the Local Ethics Committee. Then detailed history and examination were addressed for all participants.
we found that in the early correction group, constipation grade I that managed by change in diet was found in 10% of the children and grade II that managed by laxatives in 3.3% children. While in the late correction group, constipation grade I that managed by change in diet was found in 6.7% of the children, grade II that managed by laxatives in 20% children and grade III resistant to laxatives and diet in 6.7% children. There were 26 children (86.7%) with no constipation in the early correction group.
In our study we also found that in the early correction group, soiling grade I was found in 3.3% children and grade II in 3.3% children. While in late correction group, soiling grade I was found in 23.3% children, grade II in 10% children and grade III in 10% children. A statistically significant difference was observed between the two groups regarding soiling (p=0.011).
Voluntary bowel movements was found in 100% children in the early correction group and in 80% children in late correction group. Voluntary bowel movements was significantly higher in early correction group compared to late correction group (p=0.010).
Urinary incontinence for less half the time was found in just one case in the early correction group and late correction group. So there was no statistically significant difference was found between the two groups regarding urinary incontinence.
In our study the mean of the quality of life in the early and late correction groups was 12.83± 0.59 and 11.13± 2.73 respectively. So we proved that the quality of life was significantly higher in early correction group compared to late correction group (p<0.001).
After all, we proved that the early performance of anorectoplasty achieved a better bowel function, especially in terms of continence, improved soiling and good bowel movement. In addition to that the early performance of anorectoplasty has a great effect in improving the quality of life.