The impact of perioperative care on complications and short term outcome in ARM type rectovestibular fistula: An ARM-Net consortium study

Bowel function and associated risk factors at preschool and early childhood age in children with anorectal malformation type rectovestibular fistula: An ARM-Net consortium study

“…Our study revealed that an enterostomy prior to reconstruction seems to be associated with poor bowel function, and is indeed a risk factor for developing the need for bowel management. Whether the stoma itself led to worse outcome, or the underlying reason to perform an enterostomy (which was miscellaneous, such as general practice or fistulas too small to sufficiently allow passage of stool) [17] or other influencing factors not registered or accounted for in our registry, could not be discerned because of the limited information in our study.…”

“…An enterostomy as initial treatment had been performed in 17 patients (15.7%) for different reasons, e.g. general practice of the specific center, a fistula too small to allow passage of stool sufficiently, or pre/dysmaturity [17] . An additional 2 patients had an enterostomy performed during or after reconstruction (as prevention or treatment for wound complications).…”

“…Post-reconstructive complications were, however, shown to lead to the need for performing bowel management, independent of being a major or minor complication. As described in our earlier study [17] , the term 'major' needs to be interpreted with care, as taking back a patient to theater for a few additional stitches in a small dehiscence is by the Clavien-Dindo classification regarded as a major complication by definition [20] . It could be hypothesized that any negative impact on healing after reconstruction, whether minor or major, results in less developed bowel control, because of increased fibrosis, limited control on urge, or more psychosomatically impaired defecatory function or behavior, and could thereby introduce the need for bowel management.…”

“…Because BFS-data are presently not included in the ARM-Net registry, a separate Castor-database developed for our earlier study [17] was used, inviting all involved consortium members to extend data on BFS and urinary continence of their entered RVFpatients. The data from this prior study, including presence and timing of enterostomy, postoperative complications, type of complication (minor/major) and redo-surgery, were also used to identify risk factors for poor functional outcome.…”

“…Furthermore, favorable results are often attained and described in adulthood [12 , 16] , and again, mainly reported combined with data of other types of ARM [6 , 7] . Finally, surgical approach and perioperative care such as bowel preparation and antibiotic prophylaxis in RVF-patients are heterogeneous, even among specialized centers [17] . As a result, little specific data is available on the outcome of ARM type RVF and associated risk factors.…”