Objective      To investigate the bowel function after surgery and the influencing factors for the male children with the high and intermediate anorectal malformation (ARM).       Methods      Clinical data of 44 boys with high and intermediate congenital ARM admitted in our hospital from September 2012 to February 2015 were collected and analyzed retrospectively. The relationship between the defecation function with the factors such as the distance between rectal blind end and anal fossa

the muscles development around the rectum and associated congenital defects were studied.       Results       Beside one child died of accidence

the left 43 cases were divided into 3 groups according to the defecation function

that is

the good continent group (n=16)

the partially continent group (n=21)

and the worse continent group (n=6). The 37 cases of total were good or partially continent (86.0%)

and none of them had complete fecal incontinence cases. (1) The distances between rectal blind end and anal fossa were 22.38±5.48

28.81±8.79 and 56.67±20.66 mm respectively

for the good

partially and worse continent group

with significant differences among the 3 groups (P0.05). (2) Evaluation of the muscle development around the rectum showed that there was no poor muscle development in the good continent group

there were good

mild and poor muscle developments in the partially continent group

but there was no good muscle development in the worse continent group. There were significant differences among the 3 groups (P0.05). (3) Ten of 26 cases receiving MRI scanning were found having some spinal defects

and their bowel function was significantly different with the children without spinal abnormalities after surgery (P0.05). (4) There were 6 children having postoperative complications

including 5 cases of rectal prolapse and 1 of sacral position wound infection. All of them were cured after proper treatment. No significant difference was seen in the bowel function between the children with complication and those without (P0.05). (5)The cardiovascular system malformation and genitourinary defects were common associated malformations

and some cases associated with cardiac malformation and genitourinary anomalies which would be self-healed later.       Conclusion       The bowel function may be affected by the distance between rectal blind end and anal fossa as well as the muscle development around the rectum and development of the spinal nerves. It is essential to take a comprehensive assessment of the disease during the first visit

proper surgical procedures

and long-term regular follow-up after surgery into account.