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Pattern of anatomic disorder and surgical management of anorectal prolapse in anorectal malformation

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Abstract

Aim

Due to the paucity of data and controversy regarding the etiology and surgical approach for managing anorectal prolapse (ARP) after anorectoplasty, we sought to investigate the underlying anatomic disorder and the surgical outcome in managing this challenging complication.

Methods

We performed a retrospective study on 83 patients with ARP related to anorectal malformations (ARM). Logistic regression analyses were performed to detect the risk factors for the ARP severity. Surgical procedures were stratified according to identified anatomical abnormalities and surgical outcomes were analyzed.

Results

50 patients (62.7%) had high-type ARM. The original anorectoplasty had a higher rate of ARP in laparoscopic-assisted anorectoplasty (n = 49, 59.0%) versus posterior sagittal anorectoplasty (n = 11, 13.3%). ARP was associated with rectal fat hyperplasia (67.5%), dilated muscular tunnel (79.5%), longitudinal muscle (LM) discontinuity (16.9%), rectal dilation (22.9%), mislocated anus (7.2%), and excessive mobile mesorectum (3.6%). Based on the ARP severity, the patients were divided into a severe group (Group 1, n = 38) and a moderate group (Group 2, n = 45). Binary logistic regression analysis showed that hyperplasia rectal fat (OR 4.55, 95% CI 1.16–17.84), rectal dilation (OR 4.21, 95% CI 1.05–16.94), and high-type ARM (OR 2.90, 95% CI 1.14–7.39) were independent risk factors for the development of severe ARP. Complications after stratified surgical repair included wound infection in six patients (7.2%), anal stenosis in one patient (1.2%), and ARP recurrence in two patients (2.4%). Twenty-six patients without colostomy before prolapse repair were followed up for 2 to 12 years. All the patients maintained voluntary bowel movements. Following ARP repair, there was an overall higher rate of no soiling or grade 1 soiling (88.5 vs. 65.4%), but 3 of 12 patients with grade 2 constipation were upgraded to grade 3.

Conclusion

Our study shows that ARM-related anorectal prolapse is associated with excessive rectum, hyperplasia of rectal fat, mobile mesorectum, loose muscular tunnel, LM discontinuity, and anal mislocation. Surgical repair with techniques stratified according to the patients’ underlying risk factors is effective to prevent recurrence and improve the soiling continence.

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Funding

This work was supported by the CAMS Innovation Fund for Medical Sciences (2021RU015).

Author information

Author notes

  1. Long Li, Yan Zhou, and Anxiao Ming contributed equally to this study.

Authors and Affiliations

  1. Department of Pediatric Surgery, Capital Institute of Pediatrics, No.2 Yabao Road, Chaoyang District, Beijing, 100020, China

    Long Li, Yan Zhou, Anxiao Ming, Qi Li, Xu Li, Yu Tian, Xianghui Xie & Mei Diao

  2. Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China

    Long Li, Yan Zhou & Hang Xu

  3. Child Health Big Data Research Center, Capital Institute of Pediatrics, Beijing, China

    Guimin Huang

  4. Department of Thoracic Surgery, Capital Institute of Pediatrics, Beijing, China

    Yurui Wu

  5. Department of Otorhinolaryngology, Capital Institute of Pediatrics, No.2 Yabao Road, Chaoyang District, Beijing, 100020, China

    Jun Tai & Qinglong Gu

  6. Faculty of Medicine, Macau University of Science and Technology, Macau, China

    Paul K. H. Tam

  7. Department of Surgery, University of Hong Kong, Hong Kong, China

    Paul K. H. Tam

  8. Research Unit of Minimally Invasive Pediatric Surgery On Diagnosis and Treatment (2021RU015), Chinese Academy of Medical Sciences, Beijing, China

    Long Li

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  1. Long Li
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Corresponding authors

Correspondence to Long Li, Qinglong Gu or Mei Diao.

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Ethical approval was obtained from the Ethics Committee of the Capital Institute of Pediatrics.

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Written informed consents were obtained from the parents before surgery.

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Li, L., Zhou, Y., Ming, A. et al. Pattern of anatomic disorder and surgical management of anorectal prolapse in anorectal malformation. Pediatr Surg Int 38, 993–1004 (2022). https://doi.org/10.1007/s00383-022-05141-y

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