Single-stage procedures for anorectal malformations: A systematic review and meta-analysis

Hartford, Leila; Brisighelli, Giulia; Gabler, Tarryn; Westgarth-Taylor, Chris

doi:10.1016/j.jpedsurg.2021.12.024

Cited by 10 publications

(11 citation statements)

References 58 publications

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“…Discrepancies in our findings and other study findings could also be explained by the types of follow‐up employed in each of the studies. Further, it is well‐documented that ARM cases undergo surgery early in life and the prognosis and life expectancy depends on early treatment, clinical complexity, and presence of multiple malformations (Hartford, Brisighelli, Gabler, & Westgarth‐Taylor, 2022; Herman & Teitelbaum, 2012; Singh & Mehra, 2022). We were unable to examine the role of early surgery on mortality outcomes in the current study as it was beyond the scope of our data.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and mortality among children with anorectal malformation: A multi‐country analysis

Kancherla

Sundar

Tandaki

et al. 2022

Birth Defects Research

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Purpose We examined the total prevalence, trends in prevalence, and age‐specific mortality among individuals with anorectal malformation (ARM) Methods We conducted a retrospective cohort study using data from 24 population‐ and hospital‐based birth defects surveillance programs affiliated with the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR) from 18 countries and for births from 1974 to 2014. We estimated pooled and program‐specific total prevalence per 10,000 total births. Poisson regression was used to assess time trends in prevalence from 2001 to 2012 when most programs contributed data. We calculated selected age‐specific proportions of deaths, stratified by case status Results The pooled total prevalence of ARM was 3.26 per 10,000 total births (95% Confidence Interval = 3.19, 3.32) for birth years 1974–2014. About 60% of cases were multiple or syndromic. Prevalence of multiple, syndromic, and stillborn cases decreased from 2001 to 2012. The first week mortality proportion was 12.5%, 3.2%, 28.3%, and 18.2% among all, isolated, multiple, and syndromic cases, respectively Conclusions ARM is relatively rare, with multiple and syndromic cases showing decreasing prevalence during the study period. Mortality is a concern during the first week of life, and especially among multiple and syndromic cases. Our descriptive epidemiological findings increase our understanding of geographic variation in the prevalence of ARM and can be used to plan needed clinical services. Exploring factors influencing prevalence and mortality among individuals with ARM could inform future studies.

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Section: Discussionmentioning

confidence: 99%

Prevalence and mortality among children with anorectal malformation: A multi‐country analysis

Kancherla

Sundar

Tandaki

et al. 2022

Birth Defects Research

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“…The average wound dehiscence rate in our population of 1.7% is lower than the reported incidence in the literature. [4][5][6][7][8][9] We feel the factors contributing to this lowered incidence involve a combination of a standardized simple protocol and the addition of the para-U-stitch to our operative technique. Mechanical bowel prep with additional preoperative oral antibiotics has been established to significantly decrease the infection rate in rectal surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Rates range from 0 to 43% depending on the type of operation performed (with or without a stoma) and how strictly wound dehiscence is defined, with most studies finding a rate somewhere around 20 to 30%. [4][5][6][7][8][9] Rates of wound dehiscence in PSARVUPs are likely underreported but range from 14 to 19%. [10][11][12] The Pediatric Colorectal and Pelvic Learning Consortium (PCPLC), an international group of specialists in the management of ARM, Hirschsprung disease, and other pediatric colorectal/pelvic conditions defines wound dehiscence as a wound disruption requiring some type of surgical intervention within 30 days of the initial operation.…”

Section: Introductionmentioning

confidence: 99%

A Modification of the Anoplasty Technique during a Posterior Sagittal Anorectoplasty and Anorectal Vaginal Urethroplasty Closure: The Para-U-Stitch to Prevent Wound Dehiscence

et al. 2023

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Wound dehiscence after posterior sagittal anorectoplasty (PSARP) or anorectal vaginal urethroplasty (PSARVUP) for anorectal malformation (ARM) is a morbid complication. We present a novel anoplasty technique employing para-U-stitches along the anterior and posterior portions of the anoplasty, which helps buttress the midline U-stitch and evert the rectal mucosa. We hypothesized that, in addition to standardized pre- and post-operative protocols, this technique would lower rates of wound dehiscence. A retrospective review of patients who underwent primary PSARP or PSARVUP with the para-U-stitch technique from 2015-2021 was performed. Wound dehiscence was defined as wound disruption requiring operative intervention within 30 days of the index operation. Superficial wound separations were excluded. Descriptive statistics were calculated. The final cohort included 232 patients. Rectoperineal fistula (28.9%) was the most common ARM subtype. PSARP was performed in 75% and PSARVUP in 25%. The majority were reconstructed with a stoma in place (63.4%). Wound dehiscence requiring operative intervention occurred in 4 patients, for an overall dehiscence rate of 1.7%. The dehiscence rate was lower in PSARPs compared to PSARVUPs (0.6% vs 5.2%) and lower for reconstruction without a stoma compared to with a stoma (1.2% vs 2.0%). There were an additional 6 patients (2.6%) with superficial wound infections managed conservatively. We present the para-U-stitch anoplasty technique, which is an adjunct to the standard anoplasty during PSARP and PSARVUP. In conjunction with standardized pre- and post-operative protocols, this technique can help decrease rates of wound dehiscence in this patient population.

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“…The impact of staging colostomy on the prognosis of postoperative defecation function is not clearly demonstrated by the available data. There were also no discernible differences between single‐stage and staging operations in terms of the functional outcome of defecation in a recent meta‐analysis 39 …”

Section: Risk Factors Of Postoperative Fddmentioning

confidence: 96%

Research progress on risk factors of postoperative functional defecation disorder in anorectal malformation

Xiang,

Feng

et al. 2023

Pediatric Discovery

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Anorectal malformation (ARM) is a common congenital gastrointestinal malformation in neonates, which has complex pathological changes and unclear etiology. The only treatment modality currently available for ARMs is through surgical treatment to correct the deformity of the anal morphology and restore normal defecation function. In addition, the mortality rates of children with ARMs have significantly decreased as a result of recent advances in medical technology. It is important to note that despite the treatment of perianal anatomical deformities, approximately one‐third of ARM patients continue to experience functional defecation disorder (FDD), which includes fecal incontinence and constipation and negatively impacts the patient's quality of life. There are still numerous questions regarding the exact cause of FDD in ARM patients following surgery. It is generally accepted that the occurrence of FDD may be related to clinical staging, structural changes in the perianal rectal muscles, anomalies of the enteric nervous system, surgical injury, etc. However, some of these factors are still controversial and require additional study to be confirmed. In this paper, we review the risk factors for FDD following surgery in ARMs, which will help us to subsequently develop appropriate interventions to enhance the anal function and improve quality of life of children with ARMs.

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Single-stage procedures for anorectal malformations: A systematic review and meta-analysis

Cited by 10 publications

References 58 publications

Prevalence and mortality among children with anorectal malformation: A multi‐country analysis

Prevalence and mortality among children with anorectal malformation: A multi‐country analysis

A Modification of the Anoplasty Technique during a Posterior Sagittal Anorectoplasty and Anorectal Vaginal Urethroplasty Closure: The Para-U-Stitch to Prevent Wound Dehiscence

Research progress on risk factors of postoperative functional defecation disorder in anorectal malformation

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