Practice of dilatation after surgical correction in anorectal malformations

Jenetzky, Ekkehart; Reckin, Sabrina; Schmiedeke, Eberhard; Schmidt, Dominik; Schwarzer, Nicole; Grasshoff‐Derr, Sabine; Zwink, Nadine; Bartels, Enrika; Rißmann, Anke; Leonhardt, Johannes; Weih, Sandra; Obermayr, Florian; Rädecke, Jochen; Palta, Markus; Kosch, Ferdinand; Götz, G. F.; Hofbauer, Ann; Schäfer, Mattias; Reutter, Heiko; Holland‐Cunz, Stefan; Märzheuser, Stefanie

doi:10.1007/s00383-012-3169-4

Cited by 26 publications

(31 citation statements)

References 7 publications

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“…The dilatations are mostly performed for a period of 6 to 8 months. 7 More recently, weekly calibration by a surgeon has been shown to achieve similar functional outcomes compared with daily parental dilatations and avoiding the psychological stress on the parents. 5 The practice in center A is to dilate neonates up to Hegar size 14, close the stoma and, often to continue using suppositories thereafter.…”

Section: Discussionmentioning

confidence: 99%

“…4 Jenetzky et al also reported comparable stricture rates following definitive surgery for ARM regardless of use of RPD. 7 Our study has assessed outcomes following RPD or otherwise in two major United Kingdom pediatric surgical centers. We observed no significant differences in need for further procedures on the neoanus between the two protocols suggesting that RPD is unlikely to be a significant factor in deciding the outcomes of the anorectal reconstruction.…”

Section: Discussionmentioning

confidence: 99%

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Role of Routine Dilatations after Anorectal Reconstruction—Comparison of Two Tertiary Centers

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Role of Routine Dilatations after Anorectal Reconstruction—Comparison of Two Tertiary Centers

et al. 2018

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“…4,10 A recent survey about the pre-and postoperative management of ARMs in selected European centers and a study completed by the German Network for Congenital UroRectal Malformations (CURE-Net) showed that anal dilations are frequently carried on following a different protocol from the one suggested by Peña. 5,6 Moreover, Peña's protocol only suggests general guidelines on how to perform anal dilations and does not advice how often patients need to be followed up, or the attitude toward acute complications that may occur during anal dilations. Therefore, aims of our survey were to investigate the current practice of anal dilations among pediatric surgeons with expertise in colorectal surgery, to understand how many of the participants strictly follow Peña's protocol, to investigate what is the approach toward common complications that can occur during anal dilations, and to evaluate if different modalities to perform dilations may be associated with different outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…4 However, worldwide anal dilations are not routinely performed by all surgeons, and two recent European works showed that many centers may have created internal protocols for performing anal dilations. [5][6][7] Moreover, it has been suggested that other modalities to perform anal dilations, such as dilating the neoanus once a week rather than daily, can be as effective and safe. 8 Therefore, with our study we aim to assess the current practice of anal dilations after ARM repair in different institutions and to verify if different practices may lead to different outcomes in terms of complications.…”

Section: Introductionmentioning

confidence: 99%

The Practice of Anal Dilations following Anorectal Reconstruction in Patients with Anorectal Malformations: An International Survey

et al. 2016

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The objective of this study was to investigate the current practices of anal dilations after anorectal reconstruction for anorectal malformations (ARMs) in different centers. An online survey, consisting of 27 questions about the practice of anal dilations, was launched in March 2015 among 54 pediatric surgeons with expertise in colorectal surgery. The survey was divided into three sections. The first section included questions regarding the country of origin, the role in the department, the average number of ARM cases treated per year, and the surgical approach used to repair ARMs. The second section was accessible only for surgeons who perform anal dilations and enquired about their modality of performing anal dilations-their attitude toward complications such as rectal prolapse, bleeding, or perineal dehiscence occurring during dilations-and about the incidence of rectal prolapse and/or anal stenosis, which required surgical repair, in their series of patients with ARMs. The third section was accessible only for surgeons who do not perform anal dilations and enquired the incidence of rectal prolapse and/or anal stenosis that required surgical repair in their series of patients with ARMs. A total of 36 pediatric surgeons from 20 countries completed the survey. All participants performed anal dilations. Twenty-five (70%) surgeons performed the first dilation 14 days after anorectal reconstruction; 30 (83%) surgeons performed it in the outpatient clinic; 34 (94%) surgeons used metal dilators and 30 (83%) surgeons lubricated the dilator with an anesthetic/steroid-free ointment; 21 (59%) surgeons tailored the first dilator size to the specific anatomical features of each patient; 27 (75%) surgeons used 1-mm-diameter increments in the dilator size and 22 (61%) surgeons increased the size weekly; 16 (45%) surgeons followed up with the patients weekly until the proper dilator size was reached. This was determined according to Peña's protocol by 25 (70%) surgeons: 23(64%) surgeons initially performed dilations twice daily; 24(66%) surgeons tapered the frequency of dilations once the desired caliber was reached. No general agreement exists in the management of complications such as rectal prolapse, bleeding, or perineal dehiscence occurring during dilations. Incidence of rectal prolapse and anal stenosis was reported less than 5%, respectively, by 25(70%) and 29(81%) respondents. Anal dilations for ARM are performed worldwide according to different modalities. Prospective and randomized clinical trials could be useful to establish a standardized protocol.

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“…Moreover, many of the guidelines can and are interpreted differently by different pediatric surgical departments, for example, dilatation protocols after the final reconstructive surgery. 3 A few large case series have been reported, for example, that of Peña and other colleagues of his center, however, these often report only the experience of a single surgeon. Hence, transfer of published results may not be so easy because some surgeons have a much more limited exposure and the right interpretation depends on definitions used to describe the data.…”

Section: Introductionmentioning

confidence: 99%

The Challenges of the European Anorectal Malformations-Net Registry

et al. 2015

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Anorectal malformations (ARM) have a low prevalence, patients need specialized surgical care, and in many cases, patients born with ARM even need life-long aftercare. Due to its low prevalence most patients are still treated in low-volume pediatric surgical centers without any adequate monitoring of the outcome. Data on prevalence, comparison of different surgical techniques, and prospective outcome measurements are still scarce and difficult to interpret. In 2010, a consortium was founded (ARM-Net consortium) including several European pediatric surgical centers to collaborate more in research and share knowledge on ARM. One of the structures started by the consortium was an ARM-Net registry for the inclusion of all future patients treated in these centers. With this review, we report the structure of the ARM-Net registry, some of the results, and discuss the challenges we faced and still face after its introduction in 2010.

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Practice of dilatation after surgical correction in anorectal malformations

Abstract: Considering the high number of painful treatments, predictors for painful dilatations should be further clarified through standardized documentation and prospective evaluation in order to improve follow-up.

Cited by 26 publications

References 7 publications

Role of Routine Dilatations after Anorectal Reconstruction—Comparison of Two Tertiary Centers

Role of Routine Dilatations after Anorectal Reconstruction—Comparison of Two Tertiary Centers

The Practice of Anal Dilations following Anorectal Reconstruction in Patients with Anorectal Malformations: An International Survey

The Challenges of the European Anorectal Malformations-Net Registry

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