Anorectal malformations (ARMs) have an incidence of 1 in 5000 births and are one of the most common congenital colorectal anomalies.1 With advancements in knowledge and surgical techniques, such as the standardization of posterior sagittal anorectoplasty (PSARP), anterior sagittal anorectoplasty (ASARP), and more recently laparoscopic anorectal pull-through (LAARP) for higher ARMs, life expectancy for patients with ARMs has been increasing over the past few decades with many living into adulthood.1,2 However, malformation type plays a significant role in long-term outcomes, even after surgical correction (Table 1). As such, the concept of a “fixed” patient after surgical intervention for ARMs serves as false reassurance. Medical issues persist and need to be followed by physicians who understand ARMs to provide patients with the full spectrum of treatment modalities including medical and surgical options. In the pediatric realm, a multidisciplinary approach is used to support the patient comprehensively and collaboratively. A similar model of treatment must be carried forward as patients reach adolescence and adulthood to continue providing for all facets of their care.

Improved survival rates following ARM repair have led to increased data on long-term outcomes following ARM repair. However, the heterogeneity in types of ARMs included in study cohorts, disease severity, classifications (e.g. Krickenbeck, Wingspread, Pena), questionnaire instruments used to measure patient-reported outcomes (with differing definitions of continence), the small cohort sizes, and evolution of surgical techniques (e.g. classic abdominoperineal pull-through, PSARP, ASARP, LAARP) makes study comparison difficult. Nevertheless, the following chapter serves to review long-term considerations when caring for aging patients with ARMs (Table 2).