A Single-center Retrospective Study of Laparoscopic-Assisted Megarectosigmoid Resection with Anal Reconstruction: Long-term Functional Outcomes and Prognostic Factors

A Single-center Retrospective Study of Laparoscopic-Assisted Megarectosigmoid Resection with Anal Reconstruction: Long-term Functional Outcomes and Prognostic Factors | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article A Single-center Retrospective Study of Laparoscopic-Assisted Megarectosigmoid Resection with Anal Reconstruction: Long-term Functional Outcomes and Prognostic Factors Zheng le, Shao yifeng, Ming anxiao, luo jianfeng, liu xuelai, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6404363/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Megarectosigmoid (MRS), a complication following anorectal malformation (ARM) repair, impairs pediatric quality of life. Current treatments lack consensus due to variable efficacy. Objective To evaluate the long-term outcome of laparoscopic-assisted MRS resection with anal reconstruction (LAMR-AR) and prognostic factors in refractory MRS post-ARM repair. Methods A retrospective cohort analyzed 49 pediatric MRS patients undergoing LAMR-AR. Clinical data included imaging and surgical parameters. Patients were stratified by anal morphology: primary (normal anatomy) vs secondary (stenosis/ectopic anus). Functional outcomes were assessed via Rintala scores (R-score) and Krickenbeck criteria for soiling/constipation. Results This study enrolled a cohort of 49 pediatric patients (28 males, 21 females) with a median age of 2.75 years (interquartile range [IQR]: 1.42-3 years). Postoperatively, in primary group, constipation decreased from 92.9%(26/28 grade3:26) to 7.1%(2/28 grade2:1 grade3:1), while soiling increased from 3.6%(1/28 grade3:1) to 57.1%(16/28 grade1:9 grade2:7). As for the secondary group, constipation decreased from 85.7%(18/21 grade3:18) to 23.8%(5/21 grade2:4 grade3:1) and soiling increased from 4.8%(1/21 grade3:1) to 71.4%(15/21 grade1:2 grade2:9 grade3:4).Secondary cases showed higher complications after ARM repair rates (32.1% vs 14.3%, p = 0.04) and lower R-scores (2.8 vs 3.4, p = 0.012). Pelvic muscle abnormalities correlated with poorer R-scores ( p = 0.02). R-score improvement positively correlated with age (r = 0.306, p = 0.032). Conclusion The long-term outcomes of LAMR-AR demonstrated a better outcome in primary group than secondary group. Pelvic muscle abnormalities predict poorer bowel function after LAMR-AR, while bowel function improvement correlates with patient’s age. Figures Figure 1 Figure 2 1. Introduction Megarectosigmoid (MRS) represents a significant cause of pseudoincontinence in pediatric patients, adversely affecting their quality of life and psychosocial development. Although the precise pathogenesis of MRS remains incompletely understood, previous studies have implicated several contributing factors, including fistular stenosis, neurodevelopmental dysplasia, inadequate postoperative management of constipation, congenital distal colonic dysmotility, and associated sacral anomalies [ 1 – 3 ]. Currently, there is no consensus regarding the optimal surgical management for MRS. However, laparoscopic-assisted techniques have gained increasing acceptance among pediatric surgeons due to their minimally invasive and enhanced surgical precision. A previous study conducted by Mitani et al. [ 4 ]reported postoperative improvement in bowel function among all five pediatric cases undergoing laparoscopic surgery; however, limitations, including a small sample size and lack of long-term follow-up data, were acknowledged. To clear the laparoscopic surgery outcome of MRS, we performed this study to evaluate the long-term efficacy of laparoscopic surgery in treating MRS. Additionally, we aimed to identify potential prognostic factors through retrospective analysis. 2. Method and material This retrospective study analyzed pediatric patients diagnosed with megarectosigmoid (MRS), identified through a comprehensive review of medical records from January 2015 to December 2023. The majority of included patients (47 out of 49) underwent initial ARM surgical repair at other medical centers. These patients were subsequently referred to our institution due to persistent difficulties with defecation and dependence on regular enemas to achieve bowel evacuation. A smaller subgroup presented to our facility with soiling after ARM repair or recurrence of urethral/vaginal fistulas. All patients demonstrated significant bowel dilation on contrast enema imaging, characterized by a recto-pelvic ratio exceeding 0.61. Considering the limited effectiveness of conservative management strategies, surgical intervention was indicated in these cases [ 5 ]. All enrolled patients received standardized preoperative assessments, including sacrococcygeal radiographs (anteroposterior and lateral views), sacrococcygeal MRI, pelvic MRI, contrast enema studies, abdominal ultrasonography, echocardiography, and thoracic radiography. We collected the information of spinal cord and sacrococcygeal anomalies, pelvic muscular abnormalities, sacral ratios (Fig. 1 ), classification of ARM, surgical approach employed for ARM repair (single-stage versus staged procedures), interval between ARM and LAMR-AR surgeries, postoperative complications associated with ARM repair, and postoperative complications associated with LAMR-AR from the medical records and preoperative examinations. As for the diagnosis of pelvic muscle abnormalities before LAMR-AR, it primarily relied on morphological analysis of pelvic musculature using pelvic MRI (Fig. 2 ) by the senior radiologist[ 6 ]. And as the initial ARM corrective surgeries were predominantly performed at external pediatric institutions, complete procedural details were frequently unavailable. Consequently, surgical interventions were classified only as single-stage or staged procedures for analysis. When analyzing the outcomes after LAMR-AR, it was found that children with anal abnormalities after ARM surgery had a poorer prognosis. Therefore, to investigate the underlying causes, patients were classified into two groups based on preoperative physical examinations and the electrical stimulation findings during LAMR-AR: (1) Primary group: patients presenting without anal stenosis and with the anus correctly positioned within the center of the striated muscle complex; (2) Secondary group: patients demonstrating anal stenosis or anatomical malpositioning of the anus. Postoperative bowel function was assessed through structured telephone interviews utilizing a standardized questionnaire (attached in appendix) developed based on Rintala’s Evaluation of Fecal Continence and the 2005 Krickenbeck classification criteria. Functional outcomes were quantitatively documented as R-scores according to Rintala’s continence evaluation system. Additionally, symptoms of constipation and soiling were classified into three distinct severity grades based on the Krickenbeck classification: constipation was categorized as grade 1 if symptoms were manageable through dietary modifications alone, grade 2 if laxative therapy was required, and grade 3 if regular enemas were necessary. Similarly, soiling was defined as grade 1 if episodes occurred occasionally (1–2 times per week) without resulting in social impairment; grade 2 if episodes occurred daily but did not produce social problems; and grade 3 if continuous soiling was present, leading to significant social impairment for the patient [ 7 , 8 ]. 3. Surgical Approach The surgical procedure was initiated with the patient placed in the supine position. A 5-mm trocar was inserted through a midline umbilical incision to establish pneumoperitoneum at pressures ranging from 8 to 10 mmHg, followed by the introduction of a 30-degree laparoscope. Under laparoscopic visualization, two additional 5-mm trocars were symmetrically placed at the level of the umbilicus along the lateral borders of the rectus abdominis muscles. The extent of rectosigmoid colon dilation was carefully assessed laparoscopically. Dissection of the mesentery of the dilated sigmoid colon was performed to enable mobilization of the healthy proximal colon down to the region below the peritoneal reflection. Subsequently, the patient was repositioned into the lithotomy position. An anal retractor was utilized for adequate exposure of the anal area, and intraoperative electrical stimulation was conducted to verify alignment of the original anal opening with the striated muscle complex. A circumferential incision was then created at the mucocutaneous junction, and full-thickness rectal mobilization was performed proximally up to the peritoneal reflection, facilitating transanal extraction of the intra-abdominally mobilized colon. The markedly dilated and hypertrophic rectosigmoid colon was resected, and the proximal, normal colon was anastomosed to the anal skin using interrupted tension-free sutures with 5 − 0 or 4 − 0 polydioxanone (PDS). In cases of substantial anastomotic scarring, excision of scar tissue was carefully performed while preserving the integrity of the external sphincter. Patients presenting with concurrent rectal mucosal prolapse underwent circumferential mucosal resection. In cases of anal malpositioning, anoplasty was performed to reconstruct the anus, guided by intraoperative electrical stimulation to accurately identify the center of the striated muscle complex. 4. Statistical Methods Statistical analyses were performed using R Studio software (version 2024.12.1). Non-parametric methods were utilized for analyzing skewed data or comparisons involving both skewed and normally distributed datasets. Specifically, Mann-Whitney U tests were employed to compare independent samples, and Spearman’s rank correlation analysis was conducted to assess associations. For normally distributed continuous data, comparisons were performed using the parametric Student’s t-test. Categorical and ordinal variables were reported as frequencies and percentages and analyzed using Chi-square tests; Fisher’s exact test was applied when expected frequencies in contingency tables were less than five. Normality of continuous variables was confirmed through Shapiro-Wilk testing, with a significance level set at α = 0.05. 5. Results 5.1 Comparison between Primary and Secondary Groups A total of 54 pediatric patients who developed MRS after ARM surgery were enrolled over an 8-year study period. 5 patients were lost to follow-up, resulting in a follow-up response rate of 90.7%. 5.1.1 Patient demographics and baseline characteristics (Table 1 ) All patients included in the final analysis were older than 3 years at the time of their last follow-up. The duration of follow-up ranged from 1.17 to 9.42 years, with a median duration of 4.66 years. As for the median MRS surgery age (primary group vs secondary group): 2.75 years (IQR 1.46–3.75) vs 2 years (IQR 1.38-3) and median follow-up age: 9.92 years (IQR 7.02–10.90) vs 8.33 years (IQR 6.92–9.79), there are no statistically significant intergroup differences ( p >0.05). Among the analyzed cohort, 28 patients were classified into the primary group, while 21 were categorized into the secondary group. In the secondary group, anatomical abnormalities included anal malpositioning in 5 cases (23.8%), anal stenosis in 11 cases (52.4%), and a combination of both malpositioning and stenosis in 5 cases (23.8%). Of the anal stenosis patients, 5 demonstrated significant scar tissue formation, and all stenosis cases exhibited complete resistance to anal dilation and conservative management. The gender ratios (male to female) were 1.15 (15 males, 13 females) in the primary group and 1.62 (13 males, 8 females) in the secondary group. Krickenbeck Classification of ARM [ 7 ]:In the primary group, the distribution of anorectal malformation (ARM) subtypes was as follows: perineal/vestibular fistulas in 14 cases (50.0%), urethral fistulas in 8 cases (28.6%), anal stenosis in 2 cases (7.1%), no fistula in 1 case (3.6%), cloaca in 1 case (3.6%), vaginal fistula in 1 case (3.6%), and vesical fistula in 1 case (3.6%).In the secondary group, the distribution included perineal/vestibular fistulas in 9 cases (42.9%), urethral fistulas in 10 cases (47.6%), anal stenosis in 1 case (4.8%), and no fistula in 1 case (4.8%).For comparative analysis, ARM subtypes were categorized into three groups: (1) perineal/vestibular fistulas with anal stenosis, (2) urethral fistulas, and (3) complex anomalies (including vesical and vaginal fistulas, cloaca, and cases without fistulas). Chi-square analysis revealed no statistically significant difference in the distribution of ARM subtypes between the primary and secondary groups( p >0.05). 5.1.2 Information of Surgery (Table 2 ) (1) Surgical parameters(primary group vs secondary group) • Intersurgical interval: 2.75 years (IQR 1.25–3.75) vs 2 years (1.33-3) • Operative duration: 158.5 min (IQR 120-212.25) vs 189 min (138.5-272.5) No statistically significant intergroup differences were observed in these parameters ( p >0.05). (2) Surgical Approaches of ARM In the primary group, the majority of patients underwent single-stage ARM repair procedures (20 out of 28, 71.4%), while 8 patients (28.6%) received multi-stage operations. In the secondary group, 12 patients (57.1%) underwent single-stage procedures, and 9 patients (42.9%) underwent multi-stage interventions. No statistically significant differences in the surgical approach (single-stage vs. multi-stage) were observed between the two groups( p >0.05). (3) Complications after ARM surgery 15/49 (30.6%) developed complications: Primary group (4/28): cutaneous fistula (1), urethral fistula (1), perianal abscess (1), mucosal prolapse (1) Secondary group (11/21): wound infection/abscess (5), mucosal prolapse (6), recurrent urethral fistula (1), vaginal fistula (1), vestibular fistula (1), wound dehiscence (1) Secondary group demonstrated significantly higher complication rates ( p = 0.04). (4) Complications After LAMR-AR Regarding complications after LAMR-AR, the primary group had 4 cases (2 mucosal prolapses, 1 anastomotic leakage, 1 perianal abscess), while the secondary group had 3 cases (2 perianal infections, 1 mucosal prolapse). No statistically significant differences in postoperative complication rates were observed between the two groups( p >0.05). 5.1.3 concomitant Abnormalities (Table 3 ) (1) Pelvic Muscle Abnormalities Before LAMR-AR Pelvic MRI revealed pelvic muscular abnormalities in 9 of 49 patients (18.4%). In the primary group (3/28, 10.7%), the identified abnormalities included: iliococcygeus muscle (2), puborectalis muscle (2), coccygeus muscle (1), and external anal sphincter (1). In the secondary group (6/21, 28.6%), abnormalities involved: puborectalis muscle (4), external anal sphincter (4), and iliococcygeus muscle (2). There were no statistically significant differences in the incidence of pelvic muscle abnormalities between the two groups( p >0.05). (2) spinal or sacrococcygeal anomalies Sacrococcygeal imaging identified spinal anomalies in 4 out of 49 patients (8.2%), including one case of presacral teratoma in the primary group and three cases of tethered cord in the secondary group. Sacrococcygeal malformations were observed in 15 patients (30.6%): In the primary group (7/28, 25.0%): spina bifida (n = 4), sacral hypoplasia (n = 3), and loss of normal sacral curvature (n = 1). In the secondary group (8/21, 38.1%): sacral hypoplasia (n = 5), spina bifida (n = 3), loss of sacral curvature (n = 2), and hemivertebra (n = 1). There were no statistically significant differences in the incidence of spinal or sacrococcygeal anomalies between the two groups( p >0.05). (3) Comorbidities Comorbidities were identified in 15 out of 49 patients (30.6%), with genitourinary anomalies being the most common (n = 10), including renal duplication, penoscrotal transposition, vesicoureteral reflux, hypospadias, ureterocele, horseshoe kidney, hydronephrosis, and fused kidney. Cardiovascular anomalies were observed in 4 patients, comprising atrial septal defect, ventricular septal defect, patent ductus arteriosus, and tetralogy of Fallot. Comorbidities were distributed as follows: 9 cases in the primary group and 7 in the secondary group, with no statistically significant difference between groups( p >0.05). Overall, associated anomalies were present in 24 of 49 ARM patients (48.98%), with spinal/sacrococcygeal malformations, genitourinary abnormalities, and cardiovascular defects representing the most prevalent associations. These findings are consistent with previously reported data by de Blaauw et al [ 9 ]. (4) Sacral Ratio (SR) Analysis Using Peña 's SR classification (normal: >0.7; moderate: 0.41–0.69; poor: 0.7 (16/28), SR 0.41–0.69 (8/28), missing data (4/28) Secondary group: SR > 0.7 (11/21), SR 0.41–0.69 (8/21), missing data (2/21) No intergroup SR differences were observed( p >0.05). 5.1.4 Outcomes (Table 4 ) The primary group (PG) demonstrated significantly better postoperative bowel function, with a higher median Rintala score of 17 (interquartile range [IQR]: 15–19) compared to 14 (IQR: 11–16) in the secondary group (SG) ( p = 0.012). Postoperative changes in constipation and soiling were as follows: In the primary group, constipation markedly decreased from 92.9% (26/28, all grade 3) preoperatively to 7.1% (2/28; grade 2: n = 1, grade 3: n = 1) postoperatively. However, soiling increased from 3.6% (1/28, grade 3) to 57.1% (16/28; grade 1: n = 9, grade 2: n = 7). One patient in this group developed fecal incontinence following LAMR-AR. In the secondary group, constipation declined from 85.7% (18/21, all grade 3) to 23.8% (5/21; grade 2: n = 4, grade 3: n = 1). Soiling increased from 4.8% (1/21, grade 3) to 71.4% (15/21; grade 1: n = 2, grade 2: n = 9, grade 3: n = 4). While the overall postoperative soiling rate did not differ significantly between groups (PG: 16/28 vs SG: 15/21, p = 0.305), the secondary group exhibited a significantly higher proportion of moderate-to-severe soiling (grade 2/3). Specifically, the distribution was PG: grade 1:2/3 = 9:7; SG: grade 1:2/3 = 2:13 ( p = 0.013).Postoperative management strategies included no intervention in 34 patients (PG: 23, SG: 11), laxative in 13 patients (PG: 4, SG: 9), and colonic irrigation in 2 patients (PG: 1, SG: 1). 5.2 Prognostic Analysis of MRS (See Table 5 , Table 6 ) Statistical analysis revealed no significant associations between postoperative Rintala scores (R-scores) following LAMR-AR and the following variables: surgical approach for ARM (single-stage vs. staged procedures), postoperative complications after LAMR-AR, presence of spinal anomalies, sacrococcygeal malformations, sacral ratio (SR), or comorbidities.However, pelvic muscle abnormalities were significantly associated with poorer postoperative bowel function ( p = 0.02). Additionally, a positive correlation was observed between R-scores and age at follow-up (r = 0.306, p = 0.032), suggesting that functional outcomes will globally improve with age. Furthermore, patients with moderate to severe soiling (grades 2–3) were significantly younger at follow-up than those with none or mild soiling (grades 0–1), with median ages of 7.25 years vs. 9.83 years, respectively ( p = 0.048). This indicates that younger patients were more likely to experience severe soiling following LAMR-AR. 6. Discussion Megarectosigmoid (MRS) is reported in approximately 10–50% of patients with anorectal malformations (ARM), with a notably higher incidence among ARM subtypes characterized by well-developed anal sphincter complexes [ 1 ]. Children with MRS are particularly susceptible to fecal overflow incontinence, nocturnal enuresis, and dyschezia, all of which significantly impair quality of life[ 12 – 14 ]. Despite its clinical relevance, the pathogenesis of MRS remains incompletely understood. Current hypotheses suggest that delayed maturation or dysfunction of enteric ganglion cells leads to impaired peristalsis, promoting fecal retention, progressive colonic dilation, and a self-reinforcing cycle of dysmotility culminating in MRS [ 1 , 3 , 5 , 14 ]. Sathyaprasa et al. proposed differing mechanisms underlying MRS development in low-type versus high-type ARM. In low-type ARM, secondary megacolon may arise due to chronic constipation and insufficient postoperative bowel management. Conversely, in high-type ARM, MRS may result from congenital colonic dilation initiated in utero, pointing toward distinct etiological pathways. Additional contributing factors include sacral dysplasia and iatrogenic disruption of the sacrorectal anatomical relationships during surgical intervention, which may compromise neuromuscular coordination [ 2 ]. Moreover, distal intestinal obstruction and anal stenosis have also been implicated in MRS development [ 2 , 15 ]. Our findings support previous literature indicating a higher prevalence of MRS in ARM subtypes typically associated with more favorable functional outcomes [ 1 , 16 – 18 ]. Because in our case series of 49 MRS patients, 26 cases (53.1%) were classified as anal stenosis, perineal fistula, or vestibular fistula, while 18 cases (36.7%) presented as urethral fistula. Therapeutic management of MRS remains a subject of ongoing debate, particularly regarding the relative efficacy of conservative versus surgical approaches. A comparative study by Helena Borg reported no significant long-term differences in defecatory function between patients managed conservatively and those who underwent surgery, suggesting that surgical intervention may be best reserved for cases unresponsive to non-operative management [ 1 ]. Similarly, Yew-Wei Tan’s findings questioned the superiority of surgical treatment, demonstrating comparable functional outcomes between operative and non-operative groups. However, the surgical cohort exhibited a higher incidence of severe postoperative complications, including dependence on antegrade continence enemas (ACE) and the creation of permanent stomas [ 19 ]. Despite these findings, some researchers advocate for surgical intervention as a definitive treatment option in selected cases. Alberto Peña emphasized that surgical correction can address both chronic constipation and fecal continence impairment in MRS patients [ 14 ]. Supporting this view, a cohort study by Sathyaprasad Burjonrappa reported normalized bowel habits in 71.4% (10/14) of patients following surgical resection. Among the remaining cases, three required intermittent management for fecal incontinence, while one patient experienced alternating diarrhea-constipation requiring additional therapy [ 2 ]. Likewise, Yasuyuki Mitani performed laparoscopic-assisted total resection and endorectal pull-through in five patients, with all demonstrating substantial postoperative improvement. Notably, three patients became completely independent from pharmacologic therapies, and the remaining two required only occasional glycerin suppositories for symptom control [ 4 ]. At our institution, surgical resection is considered a complementary strategy to conservative management and is selectively applied in patients with persistent symptoms and radiologically confirmed colonic dilation. The LAMR-AR offers several advantages, including operative precision, minimal invasiveness, and the ability to simultaneously correct coexisting anomalies such as rectal mucosal prolapse, anal stenosis, and ectopic anal malposition. When analyzing postoperative outcomes following LAMR-AR, we observed a significant decrease in constipation compared to preoperative status; however, fecal soiling increased postoperatively. Further analysis revealed that severe fecal soiling predominantly occurred in patients with anal anomalies after ARM. Additionally, patients with anal anomalies generally exhibited lower postoperative R scores. Therefore, to investigate the underlying causes, patients were stratified into two groups for comparative analysis based on the presence or absence of concomitant anal anomalies. Postoperative defecation outcomes in the primary group showed 17 cases categorized as normal R score after LAMR-AR, 9 cases as good score, with no moderate scores recorded and 2 cases poor score. Constipation occurred after LAMR-AR in 2 patients (7.1%), with 1 requiring glycerin suppositories and the other necessitating enema administration. Soiling complications were observed in 16 cases (57.1%), comprising 9 grade 1 and 7 grade 2 cases. Therapeutic interventions (5/28 17.9%) included glycerin suppositories in 4 cases and enema in 1 case. Compared with other studies, In Yew-Wei Tan's study, among the 7 children who underwent surgical treatment, 4 (57%) developed soiling (grade 2), and 6 (86%) experienced constipation (grade 2: 1; grade 3: 5). As for medical interventions (85.7% 6/7), one case required laxative intervention, and 5 cases required ACE assistance[ 19 ]. In Li Long's study, among the 6 children who underwent surgical treatment, all 6 developed soiling (grade 1: 4; grade > 1: 2), with no cases of constipation[ 5 ]. In Yasuyuki Mitani's study, among the 5 children who underwent laparoscopic surgery, 3 (60%) developed soiling (grade 1), and 2 (40%) experienced constipation (grade 3). Two cases (40%) required glycerin enema[ 4 ]. From these, we found the incidence of postoperative soiling following LAMR-AR is similar with other researches; however, improved outcomes were observed in terms of constipation and medical interventions. As for the soiling, although postoperative soiling incidence increased compared to preoperative status, 56.3% (9/16) of cases (grade 1) required no pharmacological intervention. And from the telephone follow-up, we found that grade 2 soiling primarily manifested as frequent low-volume defecation episodes correlating with soiling. Clinical use of glycerin suppositories demonstrated improvement in clinical symptoms, reducing both defecation frequency and soiling episodes. Two potential mechanisms may underlie these observations: First, the reconstructed neorectum without reservoir function due to the complete resection of the dilated bowel segment. Second, heightened peristaltic activity in the neorectum [ 2 ]. When fecal matter reaches the neorectum, the absence of competent storage capacity combined with hyperactive distal peristalsis results in increased defecation frequency and partial fecal leakage, manifesting as soiling episodes. This accounts for the clinical improvement observed following glycerin suppository administration, wherein expelling a substantial volume of fecal material in a single evacuation by the use of glycerin suppository achieves bowel emptying, thereby reducing both defecation frequency and soiling incidents. Further analysis revealed an age-dependent improvement in soiling symptoms. The median follow-up age was significantly higher in patients with grade 0/1 soiling (9.42 years; IQR: 7.44–10.88) compared to those with grade 2/3 soiling (6.67 years; IQR: 4.83–8.42) (p = 0.037). These findings suggest that as children mature, the soiling will gradually improve, which is consistent with the results of Kristiina Kyrklund 's study[ 20 ]. In summary, the surgical outcomes for primary group were satisfactory, with marked improvement in constipation and medicine intervention. Most soiling cases required either no medical intervention or responded well to glycerin suppositories. The secondary group exhibited less favorable therapeutic outcomes compared to the primary group, as reflected by significantly lower postoperative Rintala scores (median 14, IQR: 11–16 vs. 17, IQR: 15–19; p = 0.012) and a higher incidence of moderate to severe fecal soiling (grade 2/3: 13/15 vs. 7/16; p = 0.013). Within this cohort, anal anomalies included 11 cases of anal stenosis (5 with significant scar formation), 5 cases of anal malposition, and 5 cases presenting with both abnormalities. Comparative analysis between the primary and secondary groups revealed no statistically significant differences in gender distribution, age at MRS surgery, age at follow-up, ARM subtypes, surgical approach for ARM (single-stage vs. staged), presence of spinal or sacrococcygeal anomalies, pelvic muscle abnormalities, intersurgical intervals, sacral ratio, postoperative complications following LAMR-AR, operative duration, or associated congenital comorbidities. However, the incidence of post-ARM surgery complications was significantly higher in the secondary group (p = 0.004). The increased rates of anal anomalies and postoperative complications in the secondary group suggest suboptimal surgical technique or suboptimal perioperative management during the initial ARM repair, which may have led to iatrogenic pelvic neuromuscular injury. This hypothesis is further supported by the significantly higher rate of rectal prolapse in the secondary group (6/21 vs. 1/28; p = 0.033), as dysfunction of the sphincteric musculature and neural components is known to predispose to prolapse [ 21 ].Moreover, the greater technical complexity of LAMR-AR in the secondary group—likely due to scarring, anatomic distortion, and prior surgical complications—was reflected in a longer median operative time (189 minutes vs. 158.5 minutes), though this difference did not reach statistical significance (p = 0.094). This complexity may, in turn, elevate the risk of further neuromuscular injury during the procedure. Taken together, these factors likely contributed to the poorer bowel function and more severe postoperative soiling observed in the secondary group. Given the limited research on prognostic factors specific to MRS, our study employed a retrospective approach, drawing upon established predictors of surgical outcomes in ARM. However, consensus remains elusive regarding definitive factors that influence long-term functional outcomes following ARM repair. Peter C. Minneci’s multicenter study identified ARM type as the sole independent predictor of fecal continence [ 22 ]. In contrast, Marc A. Levitt (1997) emphasized that ARM associated with tethered cord is predictive of poor urinary and fecal continence outcomes [ 23 ]. He further proposed several favorable prognostic indicators, including: normal sacral and spinal anatomy, absence of sacral masses, well-defined gluteal clefts, adequate anal dimpling, and certain ARM subtypes such as perineal fistula, rectobulbar urethral fistula, rectovestibular fistula, cloaca with a common channel < 3 cm, rectal atresia or stenosis, and imperforate anus without fistula[ 16 ]. In addition, Giorgia Totonelli identified VACTERL association (Vertebral, Anorectal, Cardiac, Tracheo-Esophageal, Renal, Limb anomalies) as a poor prognostic factor [ 24 ], while van der Steeg found that tethered cord and low sacral ratio were negatively associated with functional outcomes [ 25 ].In our analysis, however, no statistically significant associations were observed between postoperative Rintala scores and the following variables: ARM type, surgical approach (single-stage vs. staged), complications after LAMR-AR, spinal or sacrococcygeal anomalies, sacral ratio, or other congenital comorbidities. The only factor significantly associated with poorer bowel function was the presence of pelvic musculature abnormalities. Among the 9 patients with documented pelvic muscle anomalies, the associated ARM subtypes included one case of persistent cloaca, one vesicorectal fistula, four urethrorectal fistulas, two perineal fistulas, and one case of anal stenosis. The etiology of these muscular abnormalities may be congenital—reflecting developmental malformations—or iatrogenic, resulting from prior surgical trauma. As for fecal continence, it depends on three main factors: sphincters, sensation, and motility. Voluntary muscle structures, which are represented by a levator muscle, muscle complex, and external sphincter, are used only for brief periods when the patient feels that it is necessary to use them [ 18 ]. So when pelvic musculature is abnormal, it leads poor bowel function after LAMR-AR. Regarding the relationship between bowel function and age, the literature presents conflicting perspectives. Helena C. Borg observed a trend toward functional improvement with increasing age[ 26 ], whereas Mohamed S. Hashish reported a decline in function in patients with high imperforate anus over time[ 27 ]. Our findings support the former, as a positive correlation was identified between R scores and age at follow-up (r = 0.306, p = 0.032), suggesting that bowel function generally shows gradual improvement with age. 7. Conclusion The long-term outcomes of LAMR-AR were more favorable in the primary group, with significant reductions in constipation and medication dependence postoperatively. Although the incidence of fecal soiling increased following surgery, all cases were limited to grade 1 or 2, most of which required either no intervention or were manageable with glycerin suppositories. Importantly, soiling symptoms demonstrated gradual improvement with advancing age, indicating potential for functional recovery over time. In contrast, the secondary group exhibited poorer functional outcomes, likely attributable to iatrogenic injury to pelvic muscles and nerves during the initial ARM surgery. The presence of pelvic musculature anomalies is associated with impaired postoperative bowel function after LAMR-AR. Conversely, follow-up age was positively correlated with improved bowel outcomes. 8. Limitation This study has several limitations. Firstly, the sample size is still relatively limited due to MRS’s rarity, which leads to a lack of generalizability representativeness in the findings. Secondly, The long interval between the LAMR-AR operation and subsequent telephonic follow-up precluded definitive documentation for some data. Tirdly, The quantification of bowel function before LAMR-AR is hindered by long interval too, compounded by the absence of established bowel habits in children under three years of age. Thus we cannot compare the R-scores before and after LAMR-AR. Declarations Funding: The project is supported by the Research Unit of Minimally Invasive Pediatric Surgery on Diagnosis and Treatment, Chinese Academy of Medical Sciences 2021RU015 Ethical approval：This study was carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki). This research was approved by the Hamilton Health Sciences/McMaster Health Sciences Research Ethics Board that operates in compliance with the ICH Good Clinical Practice Guidelines and the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans and Division 5 Health Canada Food and Drug Regulations. All patients in this study provided informed consent. (Ethics Approval Number：SHERLL2024063） Acknowledgements：Not applicable. Conflicts of Interest: The authors have no competing interests to declare that are relevant to the content of this article. Data availability：The datasets generated and/or analyzed during the current study are not publicly available due to the protection of personal privacy but are available from the corresponding author on reasonable request. Author Contribution Author ContributionsFirst Author (zheng le): Designed and conducted experiments, analyzed primary data, drafted the manuscript, and incorporated revisions.Co-authors:Shao yifeng.: Validated results, and contributed to methodology sections.Ming anxiao: Performed statistical analysis, curated datasets, and assisted in figure preparation.Luo jianfeng: Reviewed literature, interpreted findings in context of existing research, and edited the final manuscript.Corresponding Authors:Diao mei: Supervised the project’s conceptual framework, secured funding, and critically revised the manuscript for intellectual content.Li long: Oversaw data interpretation, coordinated interdisciplinary collaboration, and handled manuscript submission and peer-review correspondence. References Borg H. Megarectosigmoid in children with anorectal malformations: Long term outcome after surgical or conservative treatment. J Pediatr Surg. 2014. https://doi.org/10.1016/j.jpedsurg.2013.08.003 . Burjonrappa S, Youssef S, Lapierre S, Bensoussan A, Bouchard S. Megarectum after surgery for anorectal malformations. J Pediatr Surg. 2010;45:762–8. https://doi.org/10.1016/j.jpedsurg.2009.10.043 . Miyahara K, Kato Y, Seki T, Arakawa A, Lane GJ, Yamataka A. Neuronal immaturity in normoganglionic colon from cases of Hirschsprung disease, anorectal malformation, and idiopathic constipation. J Pediatr Surg. 2009;44:2364–8. https://doi.org/10.1016/j.jpedsurg.2009.07.066 . Mitani Y. Laparoscopic-Assisted Total Resection and Endorectal Pull-Through Technique for Congenital Megarectum with Anorectal Malformation. J Pediatr Surg. 2023. https://doi.org/10.1016/j.jpedsurg.2023.01.061 . Li L, Yan-Xia W, Xia-Na W, Jin-Zhe Z. Posterior sagittal approach: Megasigmoid resection and anal reconstruction for severe constipation and fecal incontinence after anoplasty. J Pediatr Surg. 2000;35:1058–62. https://doi.org/10.1053/jpsu.2000.7771 . AbouZeid AA, Ibrahim SE, Mohammad SA, Radwan AB, Eldebeiky M, Zaki AM. Anatomical alterations following the PSARP procedure: Correlating MRI findings with continence scores. J Pediatr Surg. 2019;54:471–8. https://doi.org/10.1016/j.jpedsurg.2018.04.025 . Rintala RJ, Lindahl H. Is normal bowel function possible after repair of intermediate and high anorectal malformations? J Pediatr Surg. 1995;30:491–4. https://doi.org/10.1016/0022-3468(95)90064-0 . Holschneider A, Hutson J, Peña A, Beket E, Chatterjee S, Coran A et al. Preliminary report on the International Conference for the Development of Standards for the Treatment of Anorectal Malformations. J Pediatr Surg. 2005;40:1521–6. https://doi.org/10.1016/j.jpedsurg.2005.08.002 De Blaauw I, Stenström P, Yamataka A, Miyake Y, Reutter H, Midrio P, et al. Anorectal malformations. Nat Rev Dis Primers. 2024;10:88. https://doi.org/10.1038/s41572-024-00574-2 . Peña A. Anorectal malformations. Semin Pediatr Surg. 1995;4:35–47. Reppucci ML, Harris KT, Wilcox DT, Peycelon M, Bischoff A. Adult urological outcomes for patients with anorectal malformation. J Pediatr Urol. 2024;20:193–9. https://doi.org/10.1016/j.jpurol.2023.12.015 . X CLSWJDJL. W, Y L, Effect of megarectum on postoperative defecation of female patients with congenital rectovestibular fistula or rectoperineal fistula. Front Pead 2023;11. https://doi.org/10.3389/fped.2023.1095054 Hodges SJ, Anthony EY. Occult megarectum–a commonly unrecognized cause of enuresis. Urology. 2012;79:421–4. https://doi.org/10.1016/j.urology.2011.10.015 . Peña A, el Behery M. Megasigmoid: a source of pseudoincontinence in children with repaired anorectal malformations. J Pediatr Surg. 1993;28:199–203. https://doi.org/10.1016/s0022-3468(05)80275-1 . Moss RL. The failed anoplasty: successful outcome after reoperative anoplasty and sigmoid resection. J Pediatr Surg. 1998;33:1145–7. https://doi.org/10.1016/s0022-3468(98)90548-6 . discussion 1147–1148. Levitt MA, Kant A, Peña A. The morbidity of constipation in patients with anorectal malformations. J Pediatr Surg. 2010;45:1228–33. https://doi.org/10.1016/j.jpedsurg.2010.02.096 . Rintala R, Lindahl H, Marttinen E, Sariola H. Constipation is a major functional complication after internal sphincter-saving posterior sagittal anorectoplasty for high and intermediate anorectal malformations. J Pediatr Surg. 1993;28:1054–8. https://doi.org/10.1016/0022-3468(93)90518-p . Levitt MA. Outcomes from the correction of anorectal malformations n.d. https://doi.org/10.1097/01.mop.0000163665.36798.ac Tan Y-W, Yin KN, Chua AYT, Cleeve S, Misra D. Treatment of megarectum in anorectal malformation with emphasis on preventive aspects: 17 years experience. Pediatr Surg Int. 2020;36:933–40. https://doi.org/10.1007/s00383-020-04687-z . Kyrklund K, Pakarinen MP, Koivusalo A, Rintala RJ. Long-term bowel functional outcomes in rectourethral fistula treated with PSARP: controlled results after 4–29 years of follow-up: a single-institution, cross-sectional study. J Pediatr Surg. 2014;49:1635–42. https://doi.org/10.1016/j.jpedsurg.2014.04.017 . Belizon A, Levitt M, Shoshany G, Rodriguez G, Peña A. Rectal prolapse following posterior sagittal anorectoplasty for anorectal malformations. J Pediatr Surg. 2005;40:192–6. https://doi.org/10.1016/j.jpedsurg.2004.09.035 . Minneci PC. Can fecal continence be predicted in patients born with anorectal malformations? J Pediatr Surg. 2019. https://doi.org/10.1016/j.jpedsurg.2019.02.035 . Levitt MA, Patel M, Rodriguez G, Gaylin DS, Pena A. The tethered spinal cord in patients with anorectal malformations. J Pediatr Surg. 1997;32:462–8. https://doi.org/10.1016/s0022-3468(97)90607-2 . Totonelli G, Catania VD, Morini F, Fusaro F, Mosiello G, Iacobelli BD, et al. VACTERL association in anorectal malformation: effect on the outcome. Pediatr Surg Int. 2015;31:805–8. https://doi.org/10.1007/s00383-015-3745-5 . van der Steeg HJJ, van Rooij IALM, Iacobelli BD, Sloots CEJ, Morandi A, Broens PMA, et al. Bowel function and associated risk factors at preschool and early childhood age in children with anorectal malformation type rectovestibular fistula: An ARM-Net consortium study. J Pediatr Surg. 2022;57:89–96. https://doi.org/10.1016/j.jpedsurg.2022.02.015 . Borg HC, Holmdahl G, Gustavsson K, Doroszkiewicz M, Sillén U. Longitudinal study of bowel function in children with anorectal malformations. J Pediatr Surg. 2013;48:597–606. https://doi.org/10.1016/j.jpedsurg.2012.10.056 . Hashish MS, Dawoud HH, Hirschl RB, Bruch SW, El Batarny AM, Mychaliska GB, et al. Long-term functional outcome and quality of life in patients with high imperforate anus. J Pediatr Surg. 2010;45:224–30. https://doi.org/10.1016/j.jpedsurg.2009.10.041 . Tables Table 1: Patient demographics and baseline characteristics P-G S-G P-Value Anal Abnormalities normal 28 stenosis 5 malposition 11 both 5 Sex male 15 13 female 13 18 0.56 LAMR-AR Age(Y) 2.75（1.46-3.75）* range：1-14 2（1.38-3） range：0.4-3 0.361 Follow-up Age（Y） 9.92（7.02-10.90） range：3-15.67 8.33（6.92-9.79） range：5-14.92 0.293 Main Symptoms defecation difficulty 26 18 fecal soiling 1 1 FDU 1 1 FDV 1 ARM classification PVF 14 9 urethral fistula 8 10 anal stenosis 2 1 vaginal fistula 1 0 cloaca 1 0 vesical fistula 1 0 no fistula 1 1 0.332 （abbreviation: P-G: Primary group; S-G: Secondary group; FDU:Fecal discharge through the urethral orifice; FDV: Fecal discharge through the vaginal canal; PVF: Perineal/Vestibular Fistula;*which means :median (IQR)） Table 2: Information of Surgery P-G S-G P-Value ARM Surgical Approach single-stage 20 12 stage 8 9 0.299 Complications after ARM surgery wound infection/abscess 1 5 mucosal prolapse 1 6 urethral fistula 1 1 vaginal fistula 0 1 vestibular fistula 0 1 wound dehiscence 0 1 cutaneous fistula 1 0 0.004 intersurgical intervals（y） 2.75 (1.25-3.75) range:0.5-9 2 (1.33-3) range:(0.42-11) 0.641 Duration of LAMR-AR（min） 158.5(120-212.25) range:62-426 189(138.5-272.5) range:(60-443) 0.094 Complication After LAMR-AR mucosal prolapses 2 1 anastomotic leakage 1 0 perianal infections 1 2 1 (abbreviation: LAMR-AR: laparoscopic-assisted MRS resection with anal reconstruction) Table 3: concomitant Abnormalities P-G S-G P-Value spinal abnormalities presacral teratoma 1 0 tethered cord 0 3 0.301 Sacrococcygeal malformations spina bifida 4 3 sacral hypoplasia 3 5 lost sacral curvature 1 2 hemivertebra 0 1 0.325 Pelvic Muscle Abnormalities iliococcygeus abnormality 2 2 puborectalis abnormality 2 4 coccygeus abnormality 1 0 external sphincter abnormality 1 4 0.146 Sacral Ratio ＞0.7 16 11 0.41-0.69 8 8 ＜0.4 0 0 missing 4 2 0.555 Comorbidities genitourinary abnormalities 4 6 cardiovascular abnormalities 3 1 Polydactyly 1 0 Rectoanal duplication 1 0 Accessory spleen 1 0 Congenital cataract 0 1 0.93 Table 4: Outcome After LAMR-AR P-G S-G R scores 17(15-19) range(6-20) 14(11-16) range(7-20) R scores(grade) normal（＞17） 17 5 good（12≤R＜17） 9 10 moderate（9≤R＜12） 0 3 poor（＜9） 2 3 soiling after LAMR-AR grade1 9 2 grade2 7 9 grade3 0 4 constipation after LAMR-AR grade1 0 0 grade2 1 4 grade3 1 1 management after LAMR-AR no intervention 23 11 laxative 4 9 colonic irrigation 1 1 (abbreviation: LAMR-AR: laparoscopic-assisted MRS resection with anal reconstruction) Table5：Factors influencing bowel function factors R scores:median (IQR） P value ARM classification PVF;Anal stenosis 16（13-19） Urethral fistula 15（10.25-17） complex anomalies 15（13.25-19） 0.130 ARM Surgical Approach single-stage 16（13-18.75） stage 15（11.5-18.5） 0.480 Complications after ARM surgery with 15（12-17） without 17（13-19） 0.083 spinal abnormalities with 15.5（9.75-17.5） without 16（12.5-19） 0.570 Sacrococcygeal malformations with 15（12-19） without 16.5（13-18.25） 0.452 Pelvic Muscle Abnormalities with（9） 12（10.5-15） without（40） 17（13.25-19） 0.022 Sacral Ratio(SR) SR≥0.7 17（12-18） SR＜0.7 15（12.25-18.25） 0.364 Complication After LAMR-AR with 18（13-20） without 16（12-18） 0.239 Comorbidities with 16（13-18.75） without 16（12-18.5） 0.756 (PVF: Perineal/Vestibular Fistula) Table6：supplementary materials Association between age and soiling soiling grade Follow-up Age（Y）:median (IQR） P value 0/1 9.83（8.13-10.88） 2/3 7.25（6.42-10.02） 0.048 Comparative analysis of follow-up age in patients with and without Pelvic Muscle Abnormalities Pelvic Muscle Abnormalities Follow-up Age（Y）:median (IQR） P value with 7.33（IQR 6.5-10.125） without 9.42 (IQR7.335-10.79) 0.296 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6404363","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":456913197,"identity":"f200bff1-01b1-4989-bffc-f5ec5425cedb","order_by":0,"name":"Zheng le","email":"","orcid":"","institution":"Children's Hospital Affiliated to Capital Institute of Pediatrics","correspondingAuthor":false,"prefix":"","firstName":"Zheng","middleName":"","lastName":"le","suffix":""},{"id":456913198,"identity":"a0607450-df15-41d9-be56-e1e530e2487c","order_by":1,"name":"Shao yifeng","email":"","orcid":"","institution":"Children's Hospital Affiliated to 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Capital Institute of Pediatrics","correspondingAuthor":true,"prefix":"","firstName":"Li","middleName":"","lastName":"long","suffix":""}],"badges":[],"createdAt":"2025-04-08 14:38:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6404363/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6404363/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":83023494,"identity":"9e86709d-ef3e-4986-866c-4e2fcba33cbb","added_by":"auto","created_at":"2025-05-19 07:56:11","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":202220,"visible":true,"origin":"","legend":"\u003cp\u003e(Measurement of SR:28.3/32.5=0.87)\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6404363/v1/4458901570006eae9c68a6eb.png"},{"id":83023868,"identity":"642e1314-6aaf-44ce-bb0e-76d147583c57","added_by":"auto","created_at":"2025-05-19 08:04:11","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":567000,"visible":true,"origin":"","legend":"\u003cp\u003eAsymmetry of the external anal sphincter was observed on T2-weighted MRI\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6404363/v1/75961760898008ef773f13b5.png"},{"id":94598641,"identity":"4da54d51-ff18-43fa-8e27-e62a3bc56326","added_by":"auto","created_at":"2025-10-28 18:55:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2383337,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6404363/v1/be2bfa00-cee5-4411-b913-29cd42ca8f03.pdf"},{"id":83023493,"identity":"cb70e51d-f25d-4353-be6b-77814144ebbd","added_by":"auto","created_at":"2025-05-19 07:56:11","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":15003,"visible":true,"origin":"","legend":"","description":"","filename":"BowelFunctionFollow.docx","url":"https://assets-eu.researchsquare.com/files/rs-6404363/v1/7ee2a3e74418c5f642f9ecc7.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"A Single-center Retrospective Study of Laparoscopic-Assisted Megarectosigmoid Resection with Anal Reconstruction: Long-term Functional Outcomes and Prognostic Factors","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eMegarectosigmoid (MRS) represents a significant cause of pseudoincontinence in pediatric patients, adversely affecting their quality of life and psychosocial development. Although the precise pathogenesis of MRS remains incompletely understood, previous studies have implicated several contributing factors, including fistular stenosis, neurodevelopmental dysplasia, inadequate postoperative management of constipation, congenital distal colonic dysmotility, and associated sacral anomalies [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Currently, there is no consensus regarding the optimal surgical management for MRS. However, laparoscopic-assisted techniques have gained increasing acceptance among pediatric surgeons due to their minimally invasive and enhanced surgical precision. A previous study conducted by Mitani et al. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]reported postoperative improvement in bowel function among all five pediatric cases undergoing laparoscopic surgery; however, limitations, including a small sample size and lack of long-term follow-up data, were acknowledged. To clear the laparoscopic surgery outcome of MRS, we performed this study to evaluate the long-term efficacy of laparoscopic surgery in treating MRS. Additionally, we aimed to identify potential prognostic factors through retrospective analysis.\u003c/p\u003e"},{"header":"2. Method and material","content":"\u003cp\u003eThis retrospective study analyzed pediatric patients diagnosed with megarectosigmoid (MRS), identified through a comprehensive review of medical records from January 2015 to December 2023. The majority of included patients (47 out of 49) underwent initial ARM surgical repair at other medical centers. These patients were subsequently referred to our institution due to persistent difficulties with defecation and dependence on regular enemas to achieve bowel evacuation. A smaller subgroup presented to our facility with soiling after ARM repair or recurrence of urethral/vaginal fistulas. All patients demonstrated significant bowel dilation on contrast enema imaging, characterized by a recto-pelvic ratio exceeding 0.61. Considering the limited effectiveness of conservative management strategies, surgical intervention was indicated in these cases [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. All enrolled patients received standardized preoperative assessments, including sacrococcygeal radiographs (anteroposterior and lateral views), sacrococcygeal MRI, pelvic MRI, contrast enema studies, abdominal ultrasonography, echocardiography, and thoracic radiography. We collected the information of spinal cord and sacrococcygeal anomalies, pelvic muscular abnormalities, sacral ratios (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), classification of ARM, surgical approach employed for ARM repair (single-stage versus staged procedures), interval between ARM and LAMR-AR surgeries, postoperative complications associated with ARM repair, and postoperative complications associated with LAMR-AR from the medical records and preoperative examinations.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAs for the diagnosis of pelvic muscle abnormalities before LAMR-AR, it primarily relied on morphological analysis of pelvic musculature using pelvic MRI (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) by the senior radiologist[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. And as the initial ARM corrective surgeries were predominantly performed at external pediatric institutions, complete procedural details were frequently unavailable. Consequently, surgical interventions were classified only as single-stage or staged procedures for analysis.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eWhen analyzing the outcomes after LAMR-AR, it was found that children with anal abnormalities after ARM surgery had a poorer prognosis. Therefore, to investigate the underlying causes, patients were classified into two groups based on preoperative physical examinations and the electrical stimulation findings during LAMR-AR: (1) Primary group: patients presenting without anal stenosis and with the anus correctly positioned within the center of the striated muscle complex; (2) Secondary group: patients demonstrating anal stenosis or anatomical malpositioning of the anus.\u003c/p\u003e \u003cp\u003ePostoperative bowel function was assessed through structured telephone interviews utilizing a standardized questionnaire (attached in appendix) developed based on Rintala\u0026rsquo;s Evaluation of Fecal Continence and the 2005 Krickenbeck classification criteria. Functional outcomes were quantitatively documented as R-scores according to Rintala\u0026rsquo;s continence evaluation system. Additionally, symptoms of constipation and soiling were classified into three distinct severity grades based on the Krickenbeck classification: constipation was categorized as grade 1 if symptoms were manageable through dietary modifications alone, grade 2 if laxative therapy was required, and grade 3 if regular enemas were necessary. Similarly, soiling was defined as grade 1 if episodes occurred occasionally (1\u0026ndash;2 times per week) without resulting in social impairment; grade 2 if episodes occurred daily but did not produce social problems; and grade 3 if continuous soiling was present, leading to significant social impairment for the patient [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e"},{"header":"3. Surgical Approach","content":"\u003cp\u003eThe surgical procedure was initiated with the patient placed in the supine position. A 5-mm trocar was inserted through a midline umbilical incision to establish pneumoperitoneum at pressures ranging from 8 to 10 mmHg, followed by the introduction of a 30-degree laparoscope. Under laparoscopic visualization, two additional 5-mm trocars were symmetrically placed at the level of the umbilicus along the lateral borders of the rectus abdominis muscles. The extent of rectosigmoid colon dilation was carefully assessed laparoscopically. Dissection of the mesentery of the dilated sigmoid colon was performed to enable mobilization of the healthy proximal colon down to the region below the peritoneal reflection. Subsequently, the patient was repositioned into the lithotomy position. An anal retractor was utilized for adequate exposure of the anal area, and intraoperative electrical stimulation was conducted to verify alignment of the original anal opening with the striated muscle complex. A circumferential incision was then created at the mucocutaneous junction, and full-thickness rectal mobilization was performed proximally up to the peritoneal reflection, facilitating transanal extraction of the intra-abdominally mobilized colon. The markedly dilated and hypertrophic rectosigmoid colon was resected, and the proximal, normal colon was anastomosed to the anal skin using interrupted tension-free sutures with 5\u0026thinsp;\u0026minus;\u0026thinsp;0 or 4\u0026thinsp;\u0026minus;\u0026thinsp;0 polydioxanone (PDS). In cases of substantial anastomotic scarring, excision of scar tissue was carefully performed while preserving the integrity of the external sphincter. Patients presenting with concurrent rectal mucosal prolapse underwent circumferential mucosal resection. In cases of anal malpositioning, anoplasty was performed to reconstruct the anus, guided by intraoperative electrical stimulation to accurately identify the center of the striated muscle complex.\u003c/p\u003e"},{"header":"4. Statistical Methods","content":"\u003cp\u003eStatistical analyses were performed using R Studio software (version 2024.12.1). Non-parametric methods were utilized for analyzing skewed data or comparisons involving both skewed and normally distributed datasets. Specifically, Mann-Whitney U tests were employed to compare independent samples, and Spearman\u0026rsquo;s rank correlation analysis was conducted to assess associations. For normally distributed continuous data, comparisons were performed using the parametric Student\u0026rsquo;s t-test. Categorical and ordinal variables were reported as frequencies and percentages and analyzed using Chi-square tests; Fisher\u0026rsquo;s exact test was applied when expected frequencies in contingency tables were less than five. Normality of continuous variables was confirmed through Shapiro-Wilk testing, with a significance level set at α\u0026thinsp;=\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"5. Results","content":"\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\n \u003ch2\u003e5.1 Comparison between Primary and Secondary Groups\u003c/h2\u003e\n \u003cp\u003eA total of 54 pediatric patients who developed MRS after ARM surgery were enrolled over an 8-year study period. 5 patients were lost to follow-up, resulting in a follow-up response rate of 90.7%.\u003c/p\u003e\n \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e\n \u003ch2\u003e5.1.1 Patient demographics and baseline characteristics (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/h2\u003e\n \u003cp\u003eAll patients included in the final analysis were older than 3 years at the time of their last follow-up. The duration of follow-up ranged from 1.17 to 9.42 years, with a median duration of 4.66 years. As for the median MRS surgery age (primary group vs secondary group): 2.75 years (IQR 1.46\u0026ndash;3.75) vs 2 years (IQR 1.38-3) and median follow-up age: 9.92 years (IQR 7.02\u0026ndash;10.90) vs 8.33 years (IQR 6.92\u0026ndash;9.79), there are no statistically significant intergroup differences (\u003cem\u003ep\u003c/em\u003e\u0026gt;0.05).\u003c/p\u003e\n \u003cp\u003eAmong the analyzed cohort, 28 patients were classified into the primary group, while 21 were categorized into the secondary group. In the secondary group, anatomical abnormalities included anal malpositioning in 5 cases (23.8%), anal stenosis in 11 cases (52.4%), and a combination of both malpositioning and stenosis in 5 cases (23.8%). Of the anal stenosis patients, 5 demonstrated significant scar tissue formation, and all stenosis cases exhibited complete resistance to anal dilation and conservative management. The gender ratios (male to female) were 1.15 (15 males, 13 females) in the primary group and 1.62 (13 males, 8 females) in the secondary group.\u003c/p\u003e\n \u003cp\u003eKrickenbeck Classification of ARM [\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e]:In the primary group, the distribution of anorectal malformation (ARM) subtypes was as follows: perineal/vestibular fistulas in 14 cases (50.0%), urethral fistulas in 8 cases (28.6%), anal stenosis in 2 cases (7.1%), no fistula in 1 case (3.6%), cloaca in 1 case (3.6%), vaginal fistula in 1 case (3.6%), and vesical fistula in 1 case (3.6%).In the secondary group, the distribution included perineal/vestibular fistulas in 9 cases (42.9%), urethral fistulas in 10 cases (47.6%), anal stenosis in 1 case (4.8%), and no fistula in 1 case (4.8%).For comparative analysis, ARM subtypes were categorized into three groups: (1) perineal/vestibular fistulas with anal stenosis, (2) urethral fistulas, and (3) complex anomalies (including vesical and vaginal fistulas, cloaca, and cases without fistulas). Chi-square analysis revealed no statistically significant difference in the distribution of ARM subtypes between the primary and secondary groups(\u003cem\u003ep\u003c/em\u003e\u0026gt;0.05).\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e\n \u003ch2\u003e\u003cstrong\u003e5.1.2 Information of Surgery\u003c/strong\u003e (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/h2\u003e\n \u003cp\u003e(1) Surgical parameters(primary group vs secondary group)\u003c/p\u003e\n \u003cp\u003e\u0026bull; Intersurgical interval: 2.75 years (IQR 1.25\u0026ndash;3.75) vs 2 years (1.33-3)\u003c/p\u003e\n \u003cp\u003e\u0026bull; Operative duration: 158.5 min (IQR 120-212.25) vs 189 min (138.5-272.5)\u003c/p\u003e\n \u003cp\u003eNo statistically significant intergroup differences were observed in these parameters (\u003cem\u003ep\u003c/em\u003e\u0026gt;0.05).\u003c/p\u003e\n \u003cp\u003e(2) Surgical Approaches of ARM\u003c/p\u003e\n \u003cp\u003eIn the primary group, the majority of patients underwent single-stage ARM repair procedures (20 out of 28, 71.4%), while 8 patients (28.6%) received multi-stage operations. In the secondary group, 12 patients (57.1%) underwent single-stage procedures, and 9 patients (42.9%) underwent multi-stage interventions. No statistically significant differences in the surgical approach (single-stage vs. multi-stage) were observed between the two groups(\u003cem\u003ep\u003c/em\u003e\u0026gt;0.05).\u003c/p\u003e\n \u003cp\u003e(3) Complications after ARM surgery\u003c/p\u003e\n \u003cp\u003e15/49 (30.6%) developed complications:\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003ePrimary group (4/28): cutaneous fistula (1), urethral fistula (1), perianal abscess (1), mucosal prolapse (1)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eSecondary group (11/21): wound infection/abscess (5), mucosal prolapse (6), recurrent urethral fistula (1), vaginal fistula (1), vestibular fistula (1), wound dehiscence (1)\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eSecondary group demonstrated significantly higher complication rates (\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.04).\u003c/p\u003e\n \u003cp\u003e(4) Complications After LAMR-AR\u003c/p\u003e\n \u003cp\u003eRegarding complications after LAMR-AR, the primary group had 4 cases (2 mucosal prolapses, 1 anastomotic leakage, 1 perianal abscess), while the secondary group had 3 cases (2 perianal infections, 1 mucosal prolapse). No statistically significant differences in postoperative complication rates were observed between the two groups(\u003cem\u003ep\u003c/em\u003e\u0026gt;0.05).\u003c/p\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e\n \u003ch2\u003e5.1.3 concomitant Abnormalities (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/h2\u003e\n \u003cp\u003e(1) Pelvic Muscle Abnormalities Before LAMR-AR\u003c/p\u003e\n \u003cp\u003ePelvic MRI revealed pelvic muscular abnormalities in 9 of 49 patients (18.4%).\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eIn the \u003cstrong\u003eprimary group\u003c/strong\u003e (3/28, 10.7%), the identified abnormalities included: iliococcygeus muscle (2), puborectalis muscle (2), coccygeus muscle (1), and external anal sphincter (1).\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eIn the \u003cstrong\u003esecondary group\u003c/strong\u003e (6/21, 28.6%), abnormalities involved: puborectalis muscle (4), external anal sphincter (4), and iliococcygeus muscle (2).\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eThere were no statistically significant differences in the incidence of pelvic muscle abnormalities between the two groups(\u003cem\u003ep\u003c/em\u003e\u0026gt;0.05).\u003c/p\u003e\n \u003cp\u003e(2) spinal or sacrococcygeal anomalies\u003c/p\u003e\n \u003cp\u003eSacrococcygeal imaging identified spinal anomalies in 4 out of 49 patients (8.2%), including one case of presacral teratoma in the primary group and three cases of tethered cord in the secondary group.\u003c/p\u003e\n \u003cp\u003eSacrococcygeal malformations were observed in 15 patients (30.6%):\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eIn the primary group (7/28, 25.0%): spina bifida (n\u0026thinsp;=\u0026thinsp;4), sacral hypoplasia (n\u0026thinsp;=\u0026thinsp;3), and loss of normal sacral curvature (n\u0026thinsp;=\u0026thinsp;1).\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eIn the secondary group (8/21, 38.1%): sacral hypoplasia (n\u0026thinsp;=\u0026thinsp;5), spina bifida (n\u0026thinsp;=\u0026thinsp;3), loss of sacral curvature (n\u0026thinsp;=\u0026thinsp;2), and hemivertebra (n\u0026thinsp;=\u0026thinsp;1).\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eThere were no statistically significant differences in the incidence of spinal or sacrococcygeal anomalies between the two groups(\u003cem\u003ep\u003c/em\u003e\u0026gt;0.05).\u003c/p\u003e\n \u003cp\u003e(3) Comorbidities\u003c/p\u003e\n \u003cp\u003eComorbidities were identified in 15 out of 49 patients (30.6%), with genitourinary anomalies being the most common (n\u0026thinsp;=\u0026thinsp;10), including renal duplication, penoscrotal transposition, vesicoureteral reflux, hypospadias, ureterocele, horseshoe kidney, hydronephrosis, and fused kidney. Cardiovascular anomalies were observed in 4 patients, comprising atrial septal defect, ventricular septal defect, patent ductus arteriosus, and tetralogy of Fallot. Comorbidities were distributed as follows: 9 cases in the primary group and 7 in the secondary group, with no statistically significant difference between groups(\u003cem\u003ep\u003c/em\u003e\u0026gt;0.05). Overall, associated anomalies were present in 24 of 49 ARM patients (48.98%), with spinal/sacrococcygeal malformations, genitourinary abnormalities, and cardiovascular defects representing the most prevalent associations. These findings are consistent with previously reported data by de Blaauw et al [\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\n \u003cp\u003e(4) Sacral Ratio (SR) Analysis\u003c/p\u003e\n \u003cp\u003eUsing Pe\u0026ntilde;a \u0026apos;s SR classification (normal: \u0026gt;0.7; moderate: 0.41\u0026ndash;0.69; poor: \u0026lt;0.4)[\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e]:\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003ePrimary group: SR\u0026thinsp;\u0026gt;\u0026thinsp;0.7 (16/28), SR 0.41\u0026ndash;0.69 (8/28), missing data (4/28)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eSecondary group: SR\u0026thinsp;\u0026gt;\u0026thinsp;0.7 (11/21), SR 0.41\u0026ndash;0.69 (8/21), missing data (2/21)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eNo intergroup SR differences were observed(\u003cem\u003ep\u003c/em\u003e\u0026gt;0.05).\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003c/div\u003e\n \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\n \u003ch2\u003e5.1.4 Outcomes (Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/h2\u003e\n \u003cp\u003eThe primary group (PG) demonstrated significantly better postoperative bowel function, with a higher median Rintala score of 17 (interquartile range [IQR]: 15\u0026ndash;19) compared to 14 (IQR: 11\u0026ndash;16) in the secondary group (SG) (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012).\u003c/p\u003e\n \u003cp\u003ePostoperative changes in constipation and soiling were as follows:\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003eIn the primary group, constipation markedly decreased from 92.9% (26/28, all grade 3) preoperatively to 7.1% (2/28; grade 2: n\u0026thinsp;=\u0026thinsp;1, grade 3: n\u0026thinsp;=\u0026thinsp;1) postoperatively. However, soiling increased from 3.6% (1/28, grade 3) to 57.1% (16/28; grade 1: n\u0026thinsp;=\u0026thinsp;9, grade 2: n\u0026thinsp;=\u0026thinsp;7). One patient in this group developed fecal incontinence following LAMR-AR.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003eIn the secondary group, constipation declined from 85.7% (18/21, all grade 3) to 23.8% (5/21; grade 2: n\u0026thinsp;=\u0026thinsp;4, grade 3: n\u0026thinsp;=\u0026thinsp;1). Soiling increased from 4.8% (1/21, grade 3) to 71.4% (15/21; grade 1: n\u0026thinsp;=\u0026thinsp;2, grade 2: n\u0026thinsp;=\u0026thinsp;9, grade 3: n\u0026thinsp;=\u0026thinsp;4).\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003eWhile the overall postoperative soiling rate did not differ significantly between groups (PG: 16/28 vs SG: 15/21, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.305), the secondary group exhibited a significantly higher proportion of moderate-to-severe soiling (grade 2/3). Specifically, the distribution was PG: grade 1:2/3\u0026thinsp;=\u0026thinsp;9:7; SG: grade 1:2/3\u0026thinsp;=\u0026thinsp;2:13 (\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.013).Postoperative management strategies included no intervention in 34 patients (PG: 23, SG: 11), laxative in 13 patients (PG: 4, SG: 9), and colonic irrigation in 2 patients (PG: 1, SG: 1).\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\n \u003ch2\u003e5.2 Prognostic Analysis of MRS (See Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e, Table \u003cspan class=\"InternalRef\"\u003e6\u003c/span\u003e)\u003c/h2\u003e\n \u003cp\u003eStatistical analysis revealed no significant associations between postoperative Rintala scores (R-scores) following LAMR-AR and the following variables: surgical approach for ARM (single-stage vs. staged procedures), postoperative complications after LAMR-AR, presence of spinal anomalies, sacrococcygeal malformations, sacral ratio (SR), or comorbidities.However, pelvic muscle abnormalities were significantly associated with poorer postoperative bowel function (\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.02). Additionally, a positive correlation was observed between R-scores and age at follow-up (r\u0026thinsp;=\u0026thinsp;0.306, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.032), suggesting that functional outcomes will globally improve with age. Furthermore, patients with moderate to severe soiling (grades 2\u0026ndash;3) were significantly younger at follow-up than those with none or mild soiling (grades 0\u0026ndash;1), with median ages of 7.25 years vs. 9.83 years, respectively (\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.048). This indicates that younger patients were more likely to experience severe soiling following LAMR-AR.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"6. Discussion","content":"\u003cp\u003eMegarectosigmoid (MRS) is reported in approximately 10\u0026ndash;50% of patients with anorectal malformations (ARM), with a notably higher incidence among ARM subtypes characterized by well-developed anal sphincter complexes [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Children with MRS are particularly susceptible to fecal overflow incontinence, nocturnal enuresis, and dyschezia, all of which significantly impair quality of life[\u003cspan additionalcitationids=\"CR13\" citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Despite its clinical relevance, the pathogenesis of MRS remains incompletely understood. Current hypotheses suggest that delayed maturation or dysfunction of enteric ganglion cells leads to impaired peristalsis, promoting fecal retention, progressive colonic dilation, and a self-reinforcing cycle of dysmotility culminating in MRS [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Sathyaprasa et al. proposed differing mechanisms underlying MRS development in low-type versus high-type ARM. In low-type ARM, secondary megacolon may arise due to chronic constipation and insufficient postoperative bowel management. Conversely, in high-type ARM, MRS may result from congenital colonic dilation initiated in utero, pointing toward distinct etiological pathways. Additional contributing factors include sacral dysplasia and iatrogenic disruption of the sacrorectal anatomical relationships during surgical intervention, which may compromise neuromuscular coordination [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Moreover, distal intestinal obstruction and anal stenosis have also been implicated in MRS development [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Our findings support previous literature indicating a higher prevalence of MRS in ARM subtypes typically associated with more favorable functional outcomes [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR17\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Because in our case series of 49 MRS patients, 26 cases (53.1%) were classified as anal stenosis, perineal fistula, or vestibular fistula, while 18 cases (36.7%) presented as urethral fistula.\u003c/p\u003e \u003cp\u003eTherapeutic management of MRS remains a subject of ongoing debate, particularly regarding the relative efficacy of conservative versus surgical approaches. A comparative study by Helena Borg reported no significant long-term differences in defecatory function between patients managed conservatively and those who underwent surgery, suggesting that surgical intervention may be best reserved for cases unresponsive to non-operative management [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Similarly, Yew-Wei Tan\u0026rsquo;s findings questioned the superiority of surgical treatment, demonstrating comparable functional outcomes between operative and non-operative groups. However, the surgical cohort exhibited a higher incidence of severe postoperative complications, including dependence on antegrade continence enemas (ACE) and the creation of permanent stomas [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Despite these findings, some researchers advocate for surgical intervention as a definitive treatment option in selected cases. Alberto Pe\u0026ntilde;a emphasized that surgical correction can address both chronic constipation and fecal continence impairment in MRS patients [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Supporting this view, a cohort study by Sathyaprasad Burjonrappa reported normalized bowel habits in 71.4% (10/14) of patients following surgical resection. Among the remaining cases, three required intermittent management for fecal incontinence, while one patient experienced alternating diarrhea-constipation requiring additional therapy [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Likewise, Yasuyuki Mitani performed laparoscopic-assisted total resection and endorectal pull-through in five patients, with all demonstrating substantial postoperative improvement. Notably, three patients became completely independent from pharmacologic therapies, and the remaining two required only occasional glycerin suppositories for symptom control [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. At our institution, surgical resection is considered a complementary strategy to conservative management and is selectively applied in patients with persistent symptoms and radiologically confirmed colonic dilation. The LAMR-AR offers several advantages, including operative precision, minimal invasiveness, and the ability to simultaneously correct coexisting anomalies such as rectal mucosal prolapse, anal stenosis, and ectopic anal malposition.\u003c/p\u003e \u003cp\u003eWhen analyzing postoperative outcomes following LAMR-AR, we observed a significant decrease in constipation compared to preoperative status; however, fecal soiling increased postoperatively. Further analysis revealed that severe fecal soiling predominantly occurred in patients with anal anomalies after ARM. Additionally, patients with anal anomalies generally exhibited lower postoperative R scores. Therefore, to investigate the underlying causes, patients were stratified into two groups for comparative analysis based on the presence or absence of concomitant anal anomalies.\u003c/p\u003e \u003cp\u003ePostoperative defecation outcomes in the primary group showed 17 cases categorized as normal R score after LAMR-AR, 9 cases as good score, with no moderate scores recorded and 2 cases poor score. Constipation occurred after LAMR-AR in 2 patients (7.1%), with 1 requiring glycerin suppositories and the other necessitating enema administration. Soiling complications were observed in 16 cases (57.1%), comprising 9 grade 1 and 7 grade 2 cases. Therapeutic interventions (5/28 17.9%) included glycerin suppositories in 4 cases and enema in 1 case. Compared with other studies, In Yew-Wei Tan's study, among the 7 children who underwent surgical treatment, 4 (57%) developed soiling (grade 2), and 6 (86%) experienced constipation (grade 2: 1; grade 3: 5). As for medical interventions (85.7% 6/7), one case required laxative intervention, and 5 cases required ACE assistance[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In Li Long's study, among the 6 children who underwent surgical treatment, all 6 developed soiling (grade 1: 4; grade\u0026thinsp;\u0026gt;\u0026thinsp;1: 2), with no cases of constipation[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. In Yasuyuki Mitani's study, among the 5 children who underwent laparoscopic surgery, 3 (60%) developed soiling (grade 1), and 2 (40%) experienced constipation (grade 3). Two cases (40%) required glycerin enema[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. From these, we found the incidence of postoperative soiling following LAMR-AR is similar with other researches; however, improved outcomes were observed in terms of constipation and medical interventions.\u003c/p\u003e \u003cp\u003eAs for the soiling, although postoperative soiling incidence increased compared to preoperative status, 56.3% (9/16) of cases (grade 1) required no pharmacological intervention. And from the telephone follow-up, we found that grade 2 soiling primarily manifested as frequent low-volume defecation episodes correlating with soiling. Clinical use of glycerin suppositories demonstrated improvement in clinical symptoms, reducing both defecation frequency and soiling episodes. Two potential mechanisms may underlie these observations: First, the reconstructed neorectum without reservoir function due to the complete resection of the dilated bowel segment. Second, heightened peristaltic activity in the neorectum [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. When fecal matter reaches the neorectum, the absence of competent storage capacity combined with hyperactive distal peristalsis results in increased defecation frequency and partial fecal leakage, manifesting as soiling episodes. This accounts for the clinical improvement observed following glycerin suppository administration, wherein expelling a substantial volume of fecal material in a single evacuation by the use of glycerin suppository achieves bowel emptying, thereby reducing both defecation frequency and soiling incidents. Further analysis revealed an age-dependent improvement in soiling symptoms. The median follow-up age was significantly higher in patients with grade 0/1 soiling (9.42 years; IQR: 7.44\u0026ndash;10.88) compared to those with grade 2/3 soiling (6.67 years; IQR: 4.83\u0026ndash;8.42) (p\u0026thinsp;=\u0026thinsp;0.037). These findings suggest that as children mature, the soiling will gradually improve, which is consistent with the results of Kristiina Kyrklund 's study[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In summary, the surgical outcomes for primary group were satisfactory, with marked improvement in constipation and medicine intervention. Most soiling cases required either no medical intervention or responded well to glycerin suppositories.\u003c/p\u003e \u003cp\u003eThe secondary group exhibited less favorable therapeutic outcomes compared to the primary group, as reflected by significantly lower postoperative Rintala scores (median 14, IQR: 11\u0026ndash;16 vs. 17, IQR: 15\u0026ndash;19; p\u0026thinsp;=\u0026thinsp;0.012) and a higher incidence of moderate to severe fecal soiling (grade 2/3: 13/15 vs. 7/16; p\u0026thinsp;=\u0026thinsp;0.013). Within this cohort, anal anomalies included 11 cases of anal stenosis (5 with significant scar formation), 5 cases of anal malposition, and 5 cases presenting with both abnormalities. Comparative analysis between the primary and secondary groups revealed no statistically significant differences in gender distribution, age at MRS surgery, age at follow-up, ARM subtypes, surgical approach for ARM (single-stage vs. staged), presence of spinal or sacrococcygeal anomalies, pelvic muscle abnormalities, intersurgical intervals, sacral ratio, postoperative complications following LAMR-AR, operative duration, or associated congenital comorbidities. However, the incidence of post-ARM surgery complications was significantly higher in the secondary group (p\u0026thinsp;=\u0026thinsp;0.004). The increased rates of anal anomalies and postoperative complications in the secondary group suggest suboptimal surgical technique or suboptimal perioperative management during the initial ARM repair, which may have led to iatrogenic pelvic neuromuscular injury. This hypothesis is further supported by the significantly higher rate of rectal prolapse in the secondary group (6/21 vs. 1/28; p\u0026thinsp;=\u0026thinsp;0.033), as dysfunction of the sphincteric musculature and neural components is known to predispose to prolapse [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e].Moreover, the greater technical complexity of LAMR-AR in the secondary group\u0026mdash;likely due to scarring, anatomic distortion, and prior surgical complications\u0026mdash;was reflected in a longer median operative time (189 minutes vs. 158.5 minutes), though this difference did not reach statistical significance (p\u0026thinsp;=\u0026thinsp;0.094). This complexity may, in turn, elevate the risk of further neuromuscular injury during the procedure. Taken together, these factors likely contributed to the poorer bowel function and more severe postoperative soiling observed in the secondary group.\u003c/p\u003e \u003cp\u003eGiven the limited research on prognostic factors specific to MRS, our study employed a retrospective approach, drawing upon established predictors of surgical outcomes in ARM. However, consensus remains elusive regarding definitive factors that influence long-term functional outcomes following ARM repair. Peter C. Minneci\u0026rsquo;s multicenter study identified ARM type as the sole independent predictor of fecal continence [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In contrast, Marc A. Levitt (1997) emphasized that ARM associated with tethered cord is predictive of poor urinary and fecal continence outcomes [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. He further proposed several favorable prognostic indicators, including: normal sacral and spinal anatomy, absence of sacral masses, well-defined gluteal clefts, adequate anal dimpling, and certain ARM subtypes such as perineal fistula, rectobulbar urethral fistula, rectovestibular fistula, cloaca with a common channel\u0026thinsp;\u0026lt;\u0026thinsp;3 cm, rectal atresia or stenosis, and imperforate anus without fistula[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In addition, Giorgia Totonelli identified VACTERL association (Vertebral, Anorectal, Cardiac, Tracheo-Esophageal, Renal, Limb anomalies) as a poor prognostic factor [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e], while van der Steeg found that tethered cord and low sacral ratio were negatively associated with functional outcomes [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].In our analysis, however, no statistically significant associations were observed between postoperative Rintala scores and the following variables: ARM type, surgical approach (single-stage vs. staged), complications after LAMR-AR, spinal or sacrococcygeal anomalies, sacral ratio, or other congenital comorbidities. The only factor significantly associated with poorer bowel function was the presence of pelvic musculature abnormalities. Among the 9 patients with documented pelvic muscle anomalies, the associated ARM subtypes included one case of persistent cloaca, one vesicorectal fistula, four urethrorectal fistulas, two perineal fistulas, and one case of anal stenosis. The etiology of these muscular abnormalities may be congenital\u0026mdash;reflecting developmental malformations\u0026mdash;or iatrogenic, resulting from prior surgical trauma. As for fecal continence, it depends on three main factors: sphincters, sensation, and motility. Voluntary muscle structures, which are represented by a levator muscle, muscle complex, and external sphincter, are used only for brief periods when the patient feels that it is necessary to use them [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. So when pelvic musculature is abnormal, it leads poor bowel function after LAMR-AR. Regarding the relationship between bowel function and age, the literature presents conflicting perspectives. Helena C. Borg observed a trend toward functional improvement with increasing age[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], whereas Mohamed S. Hashish reported a decline in function in patients with high imperforate anus over time[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Our findings support the former, as a positive correlation was identified between R scores and age at follow-up (r\u0026thinsp;=\u0026thinsp;0.306, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.032), suggesting that bowel function generally shows gradual improvement with age.\u003c/p\u003e"},{"header":"7. Conclusion","content":"\u003cp\u003eThe long-term outcomes of LAMR-AR were more favorable in the primary group, with significant reductions in constipation and medication dependence postoperatively. Although the incidence of fecal soiling increased following surgery, all cases were limited to grade 1 or 2, most of which required either no intervention or were manageable with glycerin suppositories. Importantly, soiling symptoms demonstrated gradual improvement with advancing age, indicating potential for functional recovery over time. In contrast, the secondary group exhibited poorer functional outcomes, likely attributable to iatrogenic injury to pelvic muscles and nerves during the initial ARM surgery. The presence of pelvic musculature anomalies is associated with impaired postoperative bowel function after LAMR-AR. Conversely, follow-up age was positively correlated with improved bowel outcomes.\u003c/p\u003e"},{"header":"8. Limitation","content":"\u003cp\u003eThis study has several limitations. Firstly, the sample size is still relatively limited due to MRS\u0026rsquo;s rarity, which leads to a lack of generalizability representativeness in the findings. Secondly, The long interval between the LAMR-AR operation and subsequent telephonic follow-up precluded definitive documentation for some data. Tirdly, The quantification of bowel function before LAMR-AR is hindered by long interval too, compounded by the absence of established bowel habits in children under three years of age. Thus we cannot compare the R-scores before and after LAMR-AR.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eFunding: The project is supported by the Research Unit of Minimally Invasive Pediatric Surgery on Diagnosis and Treatment, Chinese Academy of Medical Sciences 2021RU015\u003c/p\u003e\n\u003cp\u003eEthical approval：This study was carried out in accordance with The Code of Ethics of the World Medical Association (Declaration of Helsinki). This research was approved by the Hamilton Health Sciences/McMaster Health Sciences Research Ethics Board that operates in compliance with the ICH Good Clinical Practice Guidelines and the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans and Division 5 Health Canada Food and Drug Regulations. All patients in this study provided informed consent. (Ethics Approval Number：SHERLL2024063）\u003c/p\u003e\n\u003cp\u003eAcknowledgements：Not applicable.\u003c/p\u003e\n\u003cp\u003eConflicts of Interest: The authors have no competing interests to declare that are relevant to the content of this article.\u003c/p\u003e\n\u003cp\u003eData availability：The datasets generated and/or analyzed during the current study are not publicly available due to the protection of personal privacy but are available from the corresponding author on reasonable request.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthor ContributionsFirst Author (zheng le): Designed and conducted experiments, analyzed primary data, drafted the manuscript, and incorporated revisions.Co-authors:Shao yifeng.: Validated results, and contributed to methodology sections.Ming anxiao: Performed statistical analysis, curated datasets, and assisted in figure preparation.Luo jianfeng: Reviewed literature, interpreted findings in context of existing research, and edited the final manuscript.Corresponding Authors:Diao mei: Supervised the project\u0026rsquo;s conceptual framework, secured funding, and critically revised the manuscript for intellectual content.Li long: Oversaw data interpretation, coordinated interdisciplinary collaboration, and handled manuscript submission and peer-review correspondence.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eBorg H. 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J Pediatr Surg. 2013;48:597\u0026ndash;606. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jpedsurg.2012.10.056\u003c/span\u003e\u003cspan address=\"10.1016/j.jpedsurg.2012.10.056\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHashish MS, Dawoud HH, Hirschl RB, Bruch SW, El Batarny AM, Mychaliska GB, et al. Long-term functional outcome and quality of life in patients with high imperforate anus. J Pediatr Surg. 2010;45:224\u0026ndash;30. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jpedsurg.2009.10.041\u003c/span\u003e\u003cspan address=\"10.1016/j.jpedsurg.2009.10.041\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1: Patient demographics and baseline characteristics\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"784\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 193px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 270px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-G\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eS-G\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003eP-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnal Abnormalities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003enormal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003estenosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003emalposition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eboth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003efemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLAMR-AR\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;Age(Y)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 147px;\"\u003e\n \u003cp\u003e2.75（1.46-3.75）*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003erange：1-14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2（1.38-3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003erange：0.4-3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.361\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFollow-up Age（Y）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 147px;\"\u003e\n \u003cp\u003e9.92（7.02-10.90）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003erange：3-15.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e8.33（6.92-9.79）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003erange：5-14.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.293\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMain Symptoms\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003edefecation difficulty\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003efecal soiling\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eFDU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eFDV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eARM classification\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003ePVF\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eurethral fistula\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eanal stenosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003evaginal fistula\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003ecloaca\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003evesical fistula\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003eno fistula\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.332\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 193px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e（abbreviation: P-G: Primary group; S-G: Secondary group; FDU:Fecal discharge through the urethral orifice; FDV: Fecal discharge through the vaginal canal; PVF: Perineal/Vestibular Fistula;*which means :median (IQR)）\u003c/p\u003e\n\u003cp\u003eTable 2: Information of Surgery\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"851\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 252px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 258px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-G\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 274px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eS-G\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003eP-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eARM Surgical Approach\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003esingle-stage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003estage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.299\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplications after ARM surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003ewound infection/abscess\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003emucosal prolapse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 143px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eurethral fistula\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003evaginal fistula\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003evestibular fistula\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003ewound dehiscence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003ecutaneous fistula\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eintersurgical intervals（y）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 143px;\"\u003e\n \u003cp\u003e2.75 (1.25-3.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003erange:0.5-9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2 (1.33-3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003erange:(0.42-11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.641\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of LAMR-AR（min）\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 143px;\"\u003e\n \u003cp\u003e158.5(120-212.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003erange:62-426\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e189(138.5-272.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003erange:(60-443)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.094\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplication After LAMR-AR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003emucosal prolapses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eanastomotic leakage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 252px;\"\u003e\n \u003cp\u003eperianal infections\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 132px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e(abbreviation: LAMR-AR: laparoscopic-assisted MRS resection with anal reconstruction)\u003c/p\u003e\n\u003cp\u003eTable 3: concomitant Abnormalities\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"869\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 33.6941%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 25.8082%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-G\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 31.8209%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eS-G\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.1119%;\"\u003e\n \u003cp\u003eP-Value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6941%;\"\u003e\n \u003cp\u003e\u003cstrong\u003espinal abnormalities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.8082%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.2135%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.1119%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6941%;\"\u003e\n \u003cp\u003epresacral teratoma\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.8082%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.2135%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.1119%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6941%;\"\u003e\n \u003cp\u003etethered cord\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.8082%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.2135%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.1119%;\"\u003e\n \u003cp\u003e0.301\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6941%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSacrococcygeal malformations\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 25.8082%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29.2135%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.1119%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6941%;\"\u003e\n \u003cp\u003espina bifida\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.8082%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.2135%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.1119%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6941%;\"\u003e\n \u003cp\u003esacral hypoplasia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.8082%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.2135%;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.1119%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6941%;\"\u003e\n \u003cp\u003elost sacral curvature\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 25.8082%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29.2135%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.1119%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6941%;\"\u003e\n \u003cp\u003ehemivertebra\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 25.8082%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29.2135%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.1119%;\"\u003e\n \u003cp\u003e0.325\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6941%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePelvic Muscle Abnormalities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 25.8082%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29.2135%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.1119%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6941%;\"\u003e\n \u003cp\u003eiliococcygeus abnormality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 25.8082%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29.2135%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.1119%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6941%;\"\u003e\n \u003cp\u003epuborectalis abnormality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 25.8082%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29.2135%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.1119%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6941%;\"\u003e\n \u003cp\u003ecoccygeus abnormality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 25.8082%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29.2135%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 11.1119%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6941%;\"\u003e\n \u003cp\u003e\u0026nbsp;external sphincter abnormality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 25.8082%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29.2135%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.1119%;\"\u003e\n \u003cp\u003e0.146\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6941%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSacral Ratio\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 25.8082%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29.2135%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.1119%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6941%;\"\u003e\n \u003cp\u003e＞0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.8082%;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29.2135%;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.1119%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6941%;\"\u003e\n \u003cp\u003e0.41-0.69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.8082%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29.2135%;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.1119%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6941%;\"\u003e\n \u003cp\u003e＜0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.8082%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29.2135%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.1119%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6941%;\"\u003e\n \u003cp\u003emissing\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.8082%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29.2135%;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.1119%;\"\u003e\n \u003cp\u003e0.555\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6941%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.8082%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29.2135%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.1119%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6941%;\"\u003e\n \u003cp\u003egenitourinary abnormalities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.8082%;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29.2135%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.1119%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6941%;\"\u003e\n \u003cp\u003ecardiovascular abnormalities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.8082%;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 29.2135%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.1119%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6941%;\"\u003e\n \u003cp\u003ePolydactyly\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.8082%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.2135%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.1119%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6941%;\"\u003e\n \u003cp\u003eRectoanal duplication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.8082%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.2135%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.1119%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6941%;\"\u003e\n \u003cp\u003eAccessory spleen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.8082%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.2135%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.1119%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 33.6941%;\"\u003e\n \u003cp\u003eCongenital cataract\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 25.8082%;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 29.2135%;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 11.1119%;\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eTable 4: Outcome After LAMR-AR\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"672\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 244px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 243px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP-G\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"bottom\" style=\"width: 185px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eS-G\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 244px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eR scores\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e17(15-19)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003erange(6-20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e14(11-16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003erange(7-20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 244px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eR scores(grade)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 244px;\"\u003e\n \u003cp\u003enormal（＞17）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 244px;\"\u003e\n \u003cp\u003egood（12\u0026le;R＜17）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 244px;\"\u003e\n \u003cp\u003emoderate（9\u0026le;R＜12）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 134px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 244px;\"\u003e\n \u003cp\u003epoor（＜9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 244px;\"\u003e\n \u003cp\u003e\u003cstrong\u003esoiling after LAMR-AR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 244px;\"\u003e\n \u003cp\u003egrade1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 134px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 244px;\"\u003e\n \u003cp\u003egrade2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 134px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 244px;\"\u003e\n \u003cp\u003egrade3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 134px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 244px;\"\u003e\n \u003cp\u003e\u003cstrong\u003econstipation after LAMR-AR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 244px;\"\u003e\n \u003cp\u003egrade1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 134px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 244px;\"\u003e\n \u003cp\u003egrade2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 134px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 244px;\"\u003e\n \u003cp\u003egrade3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 134px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 102px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 244px;\"\u003e\n \u003cp\u003e\u003cstrong\u003emanagement after LAMR-AR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 244px;\"\u003e\n \u003cp\u003eno intervention\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 244px;\"\u003e\n \u003cp\u003elaxative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 244px;\"\u003e\n \u003cp\u003ecolonic irrigation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 134px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 84px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 102px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e(abbreviation: LAMR-AR: laparoscopic-assisted MRS resection with anal reconstruction)\u003c/p\u003e\n\u003cp\u003eTable5：Factors influencing bowel function\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"557\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 266px;\"\u003e\n \u003cp\u003efactors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003eR scores:median (IQR）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 266px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eARM classification\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 266px;\"\u003e\n \u003cp\u003ePVF;Anal stenosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e16（13-19）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 266px;\"\u003e\n \u003cp\u003eUrethral fistula\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e15（10.25-17）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 266px;\"\u003e\n \u003cp\u003ecomplex anomalies\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e15（13.25-19）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e0.130\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 266px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eARM Surgical Approach\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 266px;\"\u003e\n \u003cp\u003esingle-stage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e16（13-18.75）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 266px;\"\u003e\n \u003cp\u003estage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e15（11.5-18.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e0.480\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 266px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplications after ARM surgery\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 266px;\"\u003e\n \u003cp\u003ewith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e15（12-17）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 266px;\"\u003e\n \u003cp\u003ewithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e17（13-19）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 266px;\"\u003e\n \u003cp\u003e\u003cstrong\u003espinal abnormalities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 266px;\"\u003e\n \u003cp\u003ewith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e15.5（9.75-17.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 266px;\"\u003e\n \u003cp\u003ewithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e16（12.5-19）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e0.570\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 266px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSacrococcygeal malformations\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 266px;\"\u003e\n \u003cp\u003ewith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e15（12-19）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 266px;\"\u003e\n \u003cp\u003ewithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e16.5（13-18.25）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e0.452\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 266px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePelvic Muscle Abnormalities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 266px;\"\u003e\n \u003cp\u003ewith（9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e12（10.5-15）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 266px;\"\u003e\n \u003cp\u003ewithout（40）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e17（13.25-19）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e0.022\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 266px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSacral Ratio(SR)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 266px;\"\u003e\n \u003cp\u003eSR\u0026ge;0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e17（12-18）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 266px;\"\u003e\n \u003cp\u003eSR＜0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e15（12.25-18.25）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e0.364\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 266px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComplication After LAMR-AR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 266px;\"\u003e\n \u003cp\u003ewith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e18（13-20）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 266px;\"\u003e\n \u003cp\u003ewithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e16（12-18）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e0.239\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 266px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 266px;\"\u003e\n \u003cp\u003ewith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e16（13-18.75）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 266px;\"\u003e\n \u003cp\u003ewithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 192px;\"\u003e\n \u003cp\u003e16（12-18.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 99px;\"\u003e\n \u003cp\u003e0.756\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e(PVF: Perineal/Vestibular Fistula)\u003c/p\u003e\n\u003cp\u003eTable6：supplementary materials\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"791\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 791px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAssociation between age and soiling\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003esoiling grade\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 381px;\"\u003e\n \u003cp\u003eFollow-up Age（Y）:median (IQR）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 324px;\"\u003e\n \u003cp\u003e0/1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 381px;\"\u003e\n \u003cp\u003e9.83（8.13-10.88）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 324px;\"\u003e\n \u003cp\u003e2/3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 381px;\"\u003e\n \u003cp\u003e7.25（6.42-10.02）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e0.048\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"3\" style=\"width: 791px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComparative analysis of follow-up age in patients with and without Pelvic Muscle Abnormalities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 324px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePelvic Muscle Abnormalities\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 381px;\"\u003e\n \u003cp\u003eFollow-up Age（Y）:median (IQR）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 324px;\"\u003e\n \u003cp\u003ewith\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 381px;\"\u003e\n \u003cp\u003e7.33（IQR 6.5-10.125）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 324px;\"\u003e\n \u003cp\u003ewithout\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 381px;\"\u003e\n \u003cp\u003e9.42 (IQR7.335-10.79)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 86px;\"\u003e\n \u003cp\u003e0.296\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6404363/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6404363/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eMegarectosigmoid (MRS), a complication following anorectal malformation (ARM) repair, impairs pediatric quality of life. Current treatments lack consensus due to variable efficacy.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo evaluate the long-term outcome of laparoscopic-assisted MRS resection with anal reconstruction (LAMR-AR) and prognostic factors in refractory MRS post-ARM repair.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective cohort analyzed 49 pediatric MRS patients undergoing LAMR-AR. Clinical data included imaging and surgical parameters. Patients were stratified by anal morphology: primary (normal anatomy) vs secondary (stenosis/ectopic anus). Functional outcomes were assessed via Rintala scores (R-score) and Krickenbeck criteria for soiling/constipation.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThis study enrolled a cohort of 49 pediatric patients (28 males, 21 females) with a median age of 2.75 years (interquartile range [IQR]: 1.42-3 years). Postoperatively, in primary group, constipation decreased from 92.9%(26/28 grade3:26) to 7.1%(2/28 grade2:1 grade3:1), while soiling increased from 3.6%(1/28 grade3:1) to 57.1%(16/28 grade1:9 grade2:7). As for the secondary group, constipation decreased from 85.7%(18/21 grade3:18) to 23.8%(5/21 grade2:4 grade3:1) and soiling increased from 4.8%(1/21 grade3:1) to 71.4%(15/21 grade1:2 grade2:9 grade3:4).Secondary cases showed higher complications after ARM repair rates (32.1% vs 14.3%, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.04) and lower R-scores (2.8 vs 3.4, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.012). Pelvic muscle abnormalities correlated with poorer R-scores (\u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.02). R-score improvement positively correlated with age (r\u0026thinsp;=\u0026thinsp;0.306, \u003cem\u003ep\u0026thinsp;=\u003c/em\u003e\u0026thinsp;0.032).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe long-term outcomes of LAMR-AR demonstrated a better outcome in primary group than secondary group. Pelvic muscle abnormalities predict poorer bowel function after LAMR-AR, while bowel function improvement correlates with patient\u0026rsquo;s age.\u003c/p\u003e","manuscriptTitle":"A Single-center Retrospective Study of Laparoscopic-Assisted Megarectosigmoid Resection with Anal Reconstruction: Long-term Functional Outcomes and Prognostic Factors","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-19 07:56:07","doi":"10.21203/rs.3.rs-6404363/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"40ae52c0-d7db-43a8-b64e-cc24c684615b","owner":[],"postedDate":"May 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-28T18:16:52+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-19 07:56:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6404363","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6404363","identity":"rs-6404363","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}