Controversy of Single versus Staged Management of Anorectal Malformations
- 146 Downloads
Anorectal malformations’ (ARMs) management has taken strides over the past few decades. The advent of Posterior sagittal anorectoplasty (PSARP) and its acceptance by most people across the globe as standard procedure has given way to a debate of single vs. three-staged repair. After initial hesitancy and lot of skepticism, single-staged repair has very well established its role because of its advantages over the staged procedure. There is enough evidence which suggests that single-staged repair has got equally good outcome as that of staged repair (if not better). Further, one-staged repair offers advantages of lesser morbidity, lesser cost, and lesser burden to the family. The initially thought disadvantages of higher chances of injuries, wound infection and stress to neonates have been countered by growing evidences. The authors agree that staged procedure will continue to stay around for few specific indications like perforation peritonitis, extreme prematurity and special anatomical entities. Further, it can have more important role with advent of laparoscopy and better health infrastructure in future. But with new developments in imaging, scopes and neonatal care, single-staged repair is a feasible and safe modality for treatment of these anomalies.
KeywordsAnorectal malformation Primary PSARP Staged repair PSARP
Both authors have equally contributed in writing the manuscript. ANG will act as guarantor for the paper.
Compliance with Ethical Standards
Conflict of Interest
Source of Funding
- 2.Narasimharao KL, Yadav K, Mitra SK, Pathak IC. Congenital short colon with imperforate anus (pouch colon syndrome). Ann Pediatr Surg. 1984;1:159–67.Google Scholar
- 3.Stephens D, Smith D. Ano-rectal malformation in children. Chicago: Year Book Medical Publisher Inc; 1972. p. 14–32.Google Scholar
- 8.deVries PA, Peña A. Posterior sagittal anorectoplasty. J Pediatr Surg. 1982;17:638–43.Google Scholar
- 10.Gangopadhyay AN, Pandey V, Gupta DK, et al. Assessment and comparison of fecal continence in children following primary posterior sagittal anorectoplasty and abdominoperineal pull through for anorectal anomaly using clinical scoring and MRI. J Pediatr Surg. 2016;51:430–4.CrossRefPubMedGoogle Scholar
- 14.Freeman NV, Burge DM, Soar JS, et al. Anal evoked potentials. Z Kinderchir. 1980;31:22–30.Google Scholar
- 23.Peña A. Advances in anorectal malformations. Semin Pediatr Surg. 1997;6:165–9.Google Scholar
- 31.Elhalaby EA. Primary repair of high and intermediate anorectal malformations in the neonates. Ann Pediatr Surg. 2006;2:117–221.Google Scholar
- 37.Hutson JM, van der Putte SCJ, Penington E, Kluth D, Fiegel H. The embryology of anorectal malformations. In: Holschneider AM, Hutson JM, editors. Anorectal malformations in children. Heidelberg: Springer; 2006. p. 49–63.Google Scholar