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Survey on the management of anorectal malformations (ARM) in European pediatric surgical centers of excellence

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Abstract

Purpose

Various management strategies for anorectal malformations (ARM) have been proposed. The aim of this study was to assess the current management in centers of excellence in Europe.

Methods

An online survey on the pre- and post-operative concepts, surgical techniques, and the management of complications was sent to the representative experts of 28 selected European centers of pediatric surgery with special expertise in the treatment of ARM.

Results

The survey was completed by 25 experts from 14 countries. To assess the level of the rectal pouch in newborns 60 % of participants perform a prone cross-table X-ray and 52 % ultrasound. If an ostomy is required, 84 % create divided Peña stomas. Primary repair in the newborn period is performed in females with rectoperineal (92 %), rectovestibular (60 %), and no fistula (32 %), and in males with rectoperineal (92 %), rectourinary (17 %) and no fistula (38 %). For 68 % of surgeons, the PSARP is the preferred surgical approach for “low” malformations. Laparoscopically assisted pull-throughs are routinely performed by 48 % of experts for ARM with bladderneck and 28 % for rectoprostatic fistula. 88 % perform postoperative dilations.

Conclusions

The management of ARM in Europe is very heterogeneous. High-quality clinical studies are needed to provide scientific evidence for the optimal treatment strategies.

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References

  1. DeVries P, Peña A (1982) Posterior sagittal anorectoplasty. J Pediatr Surg 17:638–643

    Article  CAS  PubMed  Google Scholar 

  2. Peña A, DeVries PA (1982) Posterior sagittal anorectoplasty: important technical considerations and new applications. J Pediatr Surg 17:796–811

    Article  PubMed  Google Scholar 

  3. Bradnock TJ, Walker GM (2011) Evolution in the management of Hirschsprung’s disease in the UK and Ireland: a national survey of practice revisited. Ann R Coll Surg Engl 93:34–38

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Keckler SJ, Yang JC, Fraser JD, Aguayo P, Ostlie DJ, Holcomb GW III et al (2009) Contemporary practice patterns in the surgical management of Hirschsprung’s disease. J Pediatr Surg 44:1257–1260

    Article  PubMed  Google Scholar 

  5. Mollard P et al (1978) Surgical treatment of high imperforate anus with definition of the puborectalis sling by an anterior perineal approach. J Pediatr Surg 13:499–504

    Article  CAS  PubMed  Google Scholar 

  6. Chainani M (1998) The anterior sagittal approach for high imperforate anus: a simplification of the Mollard approach. J Pediatr Surg 33:670–671

    Article  CAS  PubMed  Google Scholar 

  7. Okada A et al (1992) Anterior sagittal anorectoplasty for rectovestibular and anovestibular fistula. J Pediatr Surg 27:85–88

    Article  CAS  PubMed  Google Scholar 

  8. Doria do Amaral F (1999) Treatment of anorectal anomalies by anterior perineal anorectoplasty. J Pediatr Surg 34:1315–1319

    Article  Google Scholar 

  9. Levitt M, Peña A (2006) Operative Management of Anomalies in Males. In: Holschneider AM, Hutson JM (eds) Anorectal malformations in children: embryology, diagnosis, surgical treatment, follow-up. Springer, Berlin, pp 295–302

    Google Scholar 

  10. Scott JK, Leary SD, Ness AR, Sandy JR, Persson M, Kilpatrick N, et al (2014) Centralization of services for children born with orofacial clefts in the United Kingdom: a cross-sectional survey. Cleft Palate Craniofac J. Epub ahead of print

  11. Smith ER, Butler WE, Barker FG 2nd (2004) Craniotomy for resection of pediatric brain tumors in the United States, 1988–2000: effects of provider caseloads and progressive centralization and specialization of care. Neurosurgery 54:553–563

    Article  PubMed  Google Scholar 

  12. Lundström NR, Berggren H, Björkhem G, Jögi P, Sunnegârdh J (2000) Centralization of pediatric heart surgery in Sweden. Pediatr Cardiol 21:353–357

    Article  PubMed  Google Scholar 

  13. Davenport M, Ong E, Sharif K, Alizai N, McClean P, Hadzic N et al (2011) Biliary atresia in England and Wales: results of centralization and new benchmark. J Pediatr Surg 46:1689–1694

    Article  PubMed  Google Scholar 

  14. Lampela H, Ritvanen A, Kosola S, Koivusalo A, Rintala R, Jalanko H et al (2012) National centralization of biliary atresia care to an assigned multidisciplinary team provides high-quality outcomes. Scand J Gastroenterol 47:99–107

    Article  PubMed  Google Scholar 

  15. Leonhardt J, Kuebler JF, Leute PJ, Turowski C, Becker T, Pfister ED et al (2011) Biliary atresia: lessons learned from the voluntary German registry. Eur J Pediatr Surg 21:82–87

    Article  CAS  PubMed  Google Scholar 

  16. Peña A (1995) Anorectal malformations. Semin Pediatr Surg 4:35–47

    PubMed  Google Scholar 

  17. Torre M, Martucciello G, Jasonni V (2001) Sacral development in anorectal malformations and in normal population. Pediatr Radiol 31:858–862

    Article  CAS  PubMed  Google Scholar 

  18. Warne SA, Godley ML, Owens CM, Wilcox DT (2003) The validity of sacral ratios to identify sacral abnormalities. BJU Int 91:540–544

    Article  CAS  PubMed  Google Scholar 

  19. Macedo M, Martins JL, Feitas Filho LG (2004) Sacral ratio and fecal continence in children with anorectal malformations. BJU Int 94:893–894

    Article  PubMed  Google Scholar 

  20. Wangensteen OH, Rice CO (1930) Imperforate anus. A method of determining the surgical approach. Ann Surg 92:77–81

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  21. Narasimharao KL, Prasad GR, Katariya S, Yadav K, Mitra SK, Pathak IC (1983) Prone cross-table lateral view: an alternative to the invertogram in imperforate anus. AJR Am J Roentgenol 140:227–229

    Article  CAS  PubMed  Google Scholar 

  22. Han TI, Kim IO, Kim WS (2003) Imperforate anus: US determination of the type with infracoccygeal approach. Radiology 228:226–229

    Article  PubMed  Google Scholar 

  23. Kim IO, Han TI, Kim WS, Yeon KM (2000) Transperineal ultrasonography in imperforate anus: identification of the internal fistula. J Ultrasound Med 19:211–216

    CAS  PubMed  Google Scholar 

  24. Bekhit E, Murphy F, Puri P, Hutson JM (2006) The clinical features and diagnostic guidelines for identification of anorectal malformations. In: Holschneider AM, Hutson JM (eds) Anorectal malformations in children: embryology, diagnosis, surgical treatment, follow-up. Springer-Verlag, Berlin, Heidelberg, New York, pp 185–200

    Google Scholar 

  25. Lernau OZ, Jancu J, Nissan S (1978) Demonstration of rectourinary fistulas by pressure gastrografin enema. J Pediatr Surg 13:497–498

    Article  CAS  PubMed  Google Scholar 

  26. Peña A, Migotto-Krieger M, Levitt M (2006) Colostomy in anorectal malformations: a procedure with serious but preventable complications. J Pediatr Surg 41:748–756

    Article  PubMed  Google Scholar 

  27. Oda O, Davies D, Colapinto K, Gerstle JT (2014) Loop versus divided colostomy for the management of anorectal malformations. J Pediatr Surg 49:87–90

    Article  PubMed  Google Scholar 

  28. Georgeson KE, Inge TH, Albanese CT (2000) Laparoscopically assisted anorectal pull-through for high imperforate anus—a new technique. J Pediatr Surg 35:927–930

    Article  CAS  PubMed  Google Scholar 

  29. Podevin G, Petit T, Mure PY, Gelas T, Demarche M, Allal H et al (2009) Minimal invasive surgery for anorectal malformation in boys: a multicenter study. J Laparoendosc Adv Surg Tech A 19:233–235

    Article  Google Scholar 

  30. Kimura O, Iwai N, Sasaki Y, Tsuda T, Deguchi E, Ono S et al (2010) Laparoscopic versus open abdominoperineal rectoplasty for infants with high-type anorectal malformation. J Pediatr Surg 45:2390–2393

    Article  PubMed  Google Scholar 

  31. Bischoff A, Levitt MA, Peña A (2011) Laparoscopy and its use in the repair of anorectal malformations. J Pediatr Surg 46:1609–1617

    Article  PubMed  Google Scholar 

  32. De Vos C, Arnold M, Sidler D, Moore SW (2011) A comparison of laparoscopic-assisted (LAARP) and posterior sagittal (PSAARP) anorectoplasty in the outcome of intermediate and high anorectal malformations. S Afr J Surg 49:39–43

    PubMed  Google Scholar 

  33. England RJ, Warren SL, Bezuidenhout L, Numanoglu A, Millar AJ (2012) Laparoscopic repair of anorectal malformations at the Red Cross War Memorial Children’s Hospital: taking stock. J Pediatr Surg 47:565–570

    Article  PubMed  Google Scholar 

  34. Bishoff A, Peña A, Levitt M (2013) Laparoscopic-assisted PSARP—the advantages of combining both techniques for the treatment of anorectal malformations with recto-bladderneck or high prostatic fistulas. J Pediatr Surg 48:367–371

    Article  Google Scholar 

  35. Diseth TH (2006) Dissociation following traumatic medical treatment procedures in childhood: a longitudinal follow-up. Dev Psychopathol 18:233–251

    PubMed  Google Scholar 

  36. Diseth TH, Egeland T, Emblem R (1998) Effects of anal invasive treatment and incontinence on mental health and psychosocial functioning of adolescents with Hirschsprung’s disease and low anorectal anomalies. J Pediatr Surg 33:468–475

    Article  CAS  PubMed  Google Scholar 

  37. Temple SJ, Shawyer A, Langer JC (2012) Is daily dilatation by parents necessary after surgery for Hirschsprung disease and anorectal malformations? J Pediatr Surg 47:209–212

    Article  PubMed  Google Scholar 

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Acknowledgments

We are grateful to the following participating centers for their contribution to this survey. Austria: Department of Pediatric Surgery, Sozialmedizinisches Zentrum Ost-Donauspital, Vienna. Czech Republic: Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University and Motol Hospital, Prague. Finland: Department of Pediatric Surgery, University Children’s Hospital, Helsinki. France: French Reference Center for Anorectal and Pelvic Malformations, Necker-Enfants Malades Hospital, AP-HP; Paediatric Surgery Department, Timone-Enfants, Aix-Marseille University, Marseille. Germany: Department of Pediatric Surgery, Campus Virchow Clinic, Charite University Hospital Berlin, Berlin; Department of Pediatric Surgery and Urology, Center for Child and Adolescent Health, Hospital Bremen-Mitte, Bremen; Department of Pediatric Surgery and Pediatric Urology, Children’s Hospital, Cologne; Center of Pediatric Surgery Hannover, Hannover Medical School, Hannover; Department of Pediatric Surgery, Dr. von Haunersche Kinderspital, Ludwig-Maximilians-Universität München. Ireland: National Children’s Research Centre, Our Lady’s Children’s Hospital, Dublin. Italy: Department of Pediatric Surgery, Istituto Giannina Gaslini, Genoa; Department of Pediatric Surgery, Fondazione IRCCS Ca´Granda—Ospedale Maggiore Policlinico, Milano; Department of Pediatric Surgery, University of Padua, Padova; Pediatric Surgery, Maggiore University Hospital of Parma, Parma; Department of Medical and Surgical Neonatology, Bambino Gesù Children’s Hospital, Rome. Netherlands: Department of Pediatric Surgery, Pediatric Surgical Center of Amsterdam, Emma Children’s Hospital AMC and VU Medica Center, Amsterdam; Department of Pediatric Surgery, Erasmus MC-Sophia Children’s Hospital, Rotterdam; Department of Pediatric Surgery, Radboud University Medical Center, Nijmegen. Poland: Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Gdansk. Portugal: Pediatric Surgery Department, Hospital de Braga, Braga. Spain: Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid. Sweden: Department of Pediatric Surgery, Karolinska University Hospital and Karolinska Institutet, Stockholm. Switzerland: Department of Pediatric Surgery, University Children’s Hospital Zurich, Zurich. UK: Department of Pediatric Surgery, Institute of Child Health & Great Ormond St Hospital, London

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Fondazione IRCCS Ca´Granda, Ospedale Maggiore Policlinico, Via Commenda 10, 20122, Milan, Italy

    Anna Morandi & Ernesto Leva

  2. Center of Pediatric Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany

    Benno Ure & Martin Lacher

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  1. Anna Morandi
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Correspondence to Anna Morandi.

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Morandi, A., Ure, B., Leva, E. et al. Survey on the management of anorectal malformations (ARM) in European pediatric surgical centers of excellence. Pediatr Surg Int 31, 543–550 (2015). https://doi.org/10.1007/s00383-015-3700-5

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