Outcomes after Surgical Treatment for Rectal Atresia in Children: Is There a Preferred Approach? A Systematic Review

Abstract

Rectal atresia (RA) affects only 1 to 2% of all children with anorectal malformations. No consensus on optimal treatment strategy is yet achieved. Therefore, the aim of this systematic review is to summarize all surgical interventions for RA and outcomes described in the current literature. A literature search was conducted in PubMed, Embase, Web of Science, and Cochrane Library on January 24, 2022. All studies describing treatment for RA in children (< 18 years) were included. Operation technique and postoperative complications were listed. Only descriptive analysis was anticipated. Quality of the studies was assessed using Johanna Briggs Institute critical appraisal checklist for case reports and series. The search yielded 6,716 studies of which, after duplicate removal, 4,028 were excluded based on title and abstract screening. After full-text assessment, 22 of 90 studies were included, yielding 70 patients. Posterior sagittal anorectoplasty (PSARP) and pull-through were most performed (43/70 and 18/70 patients, respectively). Four patients experienced postoperative complications: anal stenosis (n = 1), anastomotic stenosis (n = 2), and death due to a pulmonary complication (n = 1). In the low-quality literature available, most patients with RA are treated with PSARP or pull-through technique. A low complication rate of both has been described but follow-up was often not mentioned. Larger well-designed studies should be performed to determine optimal treatment strategy for children with RA. This study reflects level of evidence V.

Transanal recto-anal anastomosis for treatment of rectal atresia: a review of 4 cases

“…Comparing this technique to other techniques, all cases undergoing transanal repair reported normal bowel function after follow-up period ranging from 3–36 months. On the other hand, cases who underwent PSARP showed constipation in around 25% of the cases and occasional soiling in one patient [ 5 ].…”

“…Through this approach, exposes the rectal pouch is exposed, mobilized from the surrounding muscle fibers followed by a direct end-to-end anastomosis between the blind tips of the anus [ 4 ]. Other techniques reported in literature include magnetic compression anastomosis, Duhamel pull-through, transanal end-to-end rectoanal anastomosis and laparoscopic assisted transanal approach [ 5 ].…”

Rectal atresia and rectal stenosis: the ARM-Net Consortium experience

“…The chosen approach might differ between types of RA/RS due to distinct disease morphology, clinical presentation, and the surgeon’s preference. Many of the described treatment strategies are invasive surgical procedures (e.g., PSARP, pull-through), and little is known about their mid- and long-term postoperative outcomes in this specific patient group [ 9 ]. As all patients with ARM, also patients with RA/RS might be prone to continence problems such as soiling or constipation in the long-term [ 10 ].…”