Conservative management of anterior located anus: A medium-long term follow up

Duci, Miriam; Leon, Francesco Fascetti; Bogana, G.; Gamba, Piergiorgio; Midrio, Paola

doi:10.1016/j.jpedsurg.2021.04.003

Cited by 4 publications

(14 citation statements)

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“…However, based on the definition of AA given here, a considerable part of these cases would be nowadays termed as “non-stenotic PF”, as their anus is not completely surrounded by the sphincter. In fact, no significant association of AA with constipation has been observed in several recent reports [ 24 , 33 , 36 , 37 , 73 ]. On the other hand, some authors reported a prevalence of chronic constipation as high as 47% in female and 35% in male AA patients aged 3 months to 12 years [ 26 , 27 , 28 ].…”

Section: Resultsmentioning

confidence: 93%

“…Because of the greater proximity of the anus to the urethra, a higher rate of urinary tract infections (UTI) in females with AA or non-stenotic PF may be anticipated. Nevertheless, several studies found an equal incidence of lower UTIs compared to controls [ 73 , 75 ]. The gynecologic assessment in post-menarchal girls with AA demonstrated a mean vaginal length of 52 mm (SD: 0.24), comparable with normal reference values for age [ 78 ], normal perineal tropism, and normal perineal and vaginal flora [ 73 ].…”

Section: Resultsmentioning

confidence: 99%

“…Nevertheless, several studies found an equal incidence of lower UTIs compared to controls [ 73 , 75 ]. The gynecologic assessment in post-menarchal girls with AA demonstrated a mean vaginal length of 52 mm (SD: 0.24), comparable with normal reference values for age [ 78 ], normal perineal tropism, and normal perineal and vaginal flora [ 73 ]. As the study by Duci and colleagues also included patients with non-stenotic PF in their so-called “AA”-population [ 73 ], these outcomes favor non-operative management of patients with AA or non-stenotic PF.…”

Section: Resultsmentioning

confidence: 99%

“…Heritability has been reported for patients with either a vestibular or perineal fistula [ 88 ]. Concerning patients with AA, Duci and colleagues reported familial occurrence in 5/50 patients of their “AA” population [ 73 ]. It has also been reported that risk factors for AA are female gender, high maternal age, and later birth order [ 74 ].…”

Section: Resultsmentioning

confidence: 99%

“…“AA” was also detected in patients with esophageal atresia, cardiac anomalies, Di-George Syndrome, and Down syndrome [ 73 ]. Moreover, a female patient with “AA” was reported to present a disorder of sex differentiation with an accessory phallus, an accessory phallic urethra, and a perineal lipoma [ 89 ].…”

Section: Resultsmentioning

confidence: 99%

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Clinical Differentiation between a Normal Anus, Anterior Anus, Congenital Anal Stenosis, and Perineal Fistula: Definitions and Consequences—The ARM-Net Consortium Consensus

et al. 2022

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In the past, an anteriorly located anus was often misdiagnosed and treated as an anorectal malformation (ARM) with a perineal fistula (PF). The paper aims to define the criteria for a normal anus, an anterior anus (AA) as an anatomic variant, and milder types of ARM such as congenital anal stenosis (CAS) and PF. An extensive literature search was performed by a working group of the ARM-Net Consortium concerning the subject “Normal Anus, AA, and mild ARM”. A consensus on definitions, clinical characteristics, diagnostic management, and treatment modalities was established, and a diagnostic algorithm was proposed. The algorithm enables pediatricians, midwives, gynecologists, and surgeons to make a timely correct diagnosis of any abnormally looking anus and initiate further management if needed. Thus, the routine physical inspection of a newborn should include the inspection of the anus and define its position, relation to the external sphincter, and caliber. A correct diagnosis and use of the presented terminology will avoid misclassifications and allow the initiation of correct management. This will provide a reliable comparison of different therapeutic management and outcomes of these patient cohorts in the future.

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Section: Resultsmentioning

confidence: 93%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Clinical Differentiation between a Normal Anus, Anterior Anus, Congenital Anal Stenosis, and Perineal Fistula: Definitions and Consequences—The ARM-Net Consortium Consensus

et al. 2022

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Comparison and impact of associated anomalies on the anal position index in neonates with anorectal malformation

et al. 2022

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Objective Some prognostic factors have affected the functional outcomes of patients with anorectal malformations (ARM) after definitive surgery, including the associated anomalies. Moreover, the anal position index (API) study in neonates from developing countries is minimal. We aimed to (1) compare the API between neonates with ARM and controls; and (2) determine the impact of associated anomalies on the API in neonates with ARM. Results We ascertained 68 subjects: 35 neonates with ARM and 33 controls. The API of neonates with ARM was similar to controls, either male or female neonates (p = 0.51 and 0.90, respectively). Interestingly, the API in ARM males with associated anomalies (0.42 ± 0.07) was significantly lower than in control males (0.48 ± 0.02) (p = 0.005). Moreover, the API of ARM neonates with vertebral anomalies (0.35 ± 0.04) was lower than ARM neonates without vertebral anomalies (0.47 ± 0.07) (p = 0.021). In conclusion, associated anomalies and sex might affect the API in neonates with ARM. These findings should be considered and informed during counseling to the parents regarding the prognosis of functional outcomes in ARM neonates, particularly with associated anomalies.

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Diagnosing Mild Forms of Anorectal Malformation With Anorectal Manometry: A Prospective Study

et al. 2022

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INTRODUCTION: Rectoperineal congenital anorectal malformations (CARMs) are diagnosed by examining the perineum, combined with electric stimulation (ES) of the anal sphincter performed under anesthesia. This procedure may be troublesome because it is based on the observed contractibility of the sphincter. We aimed to add 3-dimensional high-resolution anorectal manometry (3D-HRAM) to the procedure and to assess its value for diagnosing rectoperineal forms of CARM. METHODS: We prospectively included 66 patients younger than 24 months who presented with constipation and were suspected of CARM, idiopathic constipation, or Hirschsprung disease. The patients were assessed between 2015 and 2021 at University Medical Center Groningen, the Netherlands. All patients underwent 3D-HRAM, followed by the standard diagnostic procedure for either CARM or Hirschsprung disease. RESULTS: Of the 51 patients who underwent both 3D-HRAM and ES, we observed that patients with rectoperineal CARM revealed a pressure gap along the anterior part of the anal sphincter. Based on this observation, we diagnosed 35 patients with CARM. Subsequently, all 35 diagnoses were confirmed with ES. Sixteen patients were diagnosed as not having CARM, 100% of whom were in agreement with the gold standard—ES. Both the specificity and sensitivity of 3D-HRAM for diagnosing rectoperineal CARM were 100%. DISCUSSION: We consider 3D-HRAM a reliable tool for diagnosing and excluding rectoperineal CARM. Using this method in patients suspected of CARM might keep infants from undergoing unnecessary interventions requiring anesthetics, such as ES. By providing objective insight into the functional capabilities of the anal sphincter, anorectal manometry adds to the diagnosis.

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Conservative management of anterior located anus: A medium-long term follow up

Cited by 4 publications

References 20 publications

Clinical Differentiation between a Normal Anus, Anterior Anus, Congenital Anal Stenosis, and Perineal Fistula: Definitions and Consequences—The ARM-Net Consortium Consensus

Clinical Differentiation between a Normal Anus, Anterior Anus, Congenital Anal Stenosis, and Perineal Fistula: Definitions and Consequences—The ARM-Net Consortium Consensus

Comparison and impact of associated anomalies on the anal position index in neonates with anorectal malformation

Diagnosing Mild Forms of Anorectal Malformation With Anorectal Manometry: A Prospective Study

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