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Beattie H, Subramanian T, Scudamore E, Middleton T, MacDonald C, Lindley R, Murthi G. Assessment of long-term quality of life, bowel and voiding function outcomes in patients with anorectal malformation at a single UK centre. Pediatr Surg Int 2024; 40:95. [PMID: 38565744 DOI: 10.1007/s00383-024-05684-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2024] [Indexed: 04/04/2024]
Abstract
AIMS Assess long-term quality of life (QoL), bowel and voiding function in anorectal malformation (ARM) paediatric patients. METHOD Retrospective review of ARM patients between 2007 and 2020 was performed. QoL (all patients), bowel and voiding function (> 5 yo) were assessed using the paediatric quality of life inventory (PedsQL), paediatric incontinence and constipation score (PICS) and dysfunctional voiding scoring system (DVSS), respectively. RESULTS There were 122 patients (49% female, 85 > 5 yo) with ARM. Two had died, four refused, twenty-two were non-contactable, leaving ninety-four patients (65 > 5 yo) included. Mean age was 89 months (19-183), and follow-up was 86 months (13-183). Patients had significantly poorer scores for QoL, bowel and voiding function compared to published healthy controls. 57% had poor bowel function, 32% had poor voiding function and 38% required 'ancillary aids' to facilitate function. Patients using 'ancillary aids' for voiding function had a significantly lower QoL (parent: 62 vs 77; p = 0.01, patient: 66 vs 79; p = 0.05). Bowel continence was worse in those with high vs low ARM (13 vs 20, p = 0.004) and timely vs delayed diagnosis (17 vs 24, p = 0.04). CONCLUSION Patients with ARM have significantly worse QoL, bowel and voiding function than normal healthy controls. There is a need for long-term monitoring of function and further support for these children. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Harriet Beattie
- Paediatric Surgical Unit, Sheffield Children's NHS Foundation Trust, Sheffield, S10 2TH, UK
- The Medical School, University of Sheffield, Sheffield, S10 2RX, UK
| | - Thejasvi Subramanian
- Paediatric Surgical Unit, Sheffield Children's NHS Foundation Trust, Sheffield, S10 2TH, UK
| | - Elizabeth Scudamore
- Paediatric Surgical Unit, Sheffield Children's NHS Foundation Trust, Sheffield, S10 2TH, UK
| | - Thomas Middleton
- Paediatric Surgical Unit, Sheffield Children's NHS Foundation Trust, Sheffield, S10 2TH, UK
| | - Caroline MacDonald
- Paediatric Surgical Unit, Sheffield Children's NHS Foundation Trust, Sheffield, S10 2TH, UK
| | - Richard Lindley
- Paediatric Surgical Unit, Sheffield Children's NHS Foundation Trust, Sheffield, S10 2TH, UK
| | - Govind Murthi
- Paediatric Surgical Unit, Sheffield Children's NHS Foundation Trust, Sheffield, S10 2TH, UK.
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Nagano A, Harumatsu T, Sugita K, Iwamoto Y, Ogata M, Takada L, Nishida N, Kedoin C, Murakami M, Yano K, Onishi S, Yamada K, Yamada W, Kawano T, Muto M, Kaji T, Ieiri S. Change over time in the postoperative defecation function in female patients with anovestibular fistula at a single institution: focus on the comparison of anal transposition with anterior sagittal anorectoplasty. Pediatr Surg Int 2023; 39:266. [PMID: 37673850 DOI: 10.1007/s00383-023-05554-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 09/08/2023]
Abstract
PURPOSE Anovestibular fistula (AVF) is the most common type of ARM in female patients. The present study investigated changes over time in the postoperative defecation function of female patients with AVF. METHODS Patient data were collected from 1984 to 2021. Eighty-eight female patients with AVF were enrolled. Patients' characteristics and the long-term outcome of defecation function were reviewed and analyzed retrospectively. The bowel function was evaluated according to the Japan Society of ARM Study Group evacuation score (ES). RESULTS Thirty-eight patients underwent anal transposition (AT), and 8 underwent anterior sagittal anorectoplasty (ASARP). The total evacuation score (ES) in AVF patients reached "excellent" at nine years old, regardless of the operative procedure. The constipation scores with AT showed better improvement than those with ASARP, but soiling scores in the ASARP group showed better improvement than those in the AT group. The postoperative complications did not affect the postoperative bowel function in AVF patients. CONCLUSION Most patients with AVF eventually achieved a satisfactory total ES. Given the difference in defecation score transition depending on the operative procedure or postoperative complications, it may be important to perform long-term defecation management via surgical procedures.
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Affiliation(s)
- Ayaka Nagano
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Toshio Harumatsu
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Koshiro Sugita
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Yumiko Iwamoto
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Masato Ogata
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Lynne Takada
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Nanako Nishida
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Chihiro Kedoin
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Masakazu Murakami
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Keisuke Yano
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Shun Onishi
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Koji Yamada
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Waka Yamada
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Takafumi Kawano
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Mitsuru Muto
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan
| | - Tatsuru Kaji
- Department of Pediatric Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Satoshi Ieiri
- Department of Pediatric Surgery, Medical and Dental Sciences Area, Research and Education Assembly, Research Field in Medicine and Health Sciences, Kagoshima University, Kagoshima, Japan.
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Bokova E, Prasade N, Janumpally S, Rosen JM, Lim IIP, Levitt MA, Rentea RM. State of the Art Bowel Management for Pediatric Colorectal Problems: Hirschsprung Disease. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1418. [PMID: 37628417 PMCID: PMC10453740 DOI: 10.3390/children10081418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/12/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023]
Abstract
After an initial pull-though, patients with Hirschsprung disease (HD) can present with obstructive symptoms, Hirschsprung-associated enterocolitis (HAEC), failure to thrive, or fecal soiling. This current review focuses on algorithms for evaluation and treatment in children with HD as a part of a manuscript series on updates in bowel management. In constipated patients, anatomic causes of obstruction should be excluded. Once anatomy is confirmed to be normal, laxatives, fiber, osmotic laxatives, or mechanical management can be utilized. Botulinum toxin injections are performed in all patients with HD before age five because of the nonrelaxing sphincters that they learn to overcome with increased age. Children with a patulous anus due to iatrogenic damage of the anal sphincters are offered sphincter reconstruction. Hypermotility is managed with antidiarrheals and small-volume enemas. Family education is crucial for the early detection of HAEC and for performing at-home rectal irrigations.
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Affiliation(s)
- Elizaveta Bokova
- Comprehensive Colorectal Center, Department of Surgery, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
| | - Ninad Prasade
- Comprehensive Colorectal Center, Department of Surgery, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
| | - Sanjana Janumpally
- Comprehensive Colorectal Center, Department of Surgery, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
| | - John M. Rosen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Irene Isabel P. Lim
- Comprehensive Colorectal Center, Department of Surgery, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
- Department of Surgery, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| | - Marc A. Levitt
- Division of Colorectal and Pelvic Reconstruction, Children’s National Medical Center, Washington, DC 20001, USA
| | - Rebecca M. Rentea
- Comprehensive Colorectal Center, Department of Surgery, Children’s Mercy Kansas City, Kansas City, MO 64108, USA
- Department of Surgery, University of Missouri-Kansas City, Kansas City, MO 64108, USA
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Miyake Y, Lum Min SA, Yamataka A, Keijzer R. The impact of intestinal atresia on educational and mental health outcomes in school-aged children: A case-control cohort study. Pediatr Surg Int 2023; 39:86. [PMID: 36662364 DOI: 10.1007/s00383-022-05357-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/26/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE To assess real-world educational outcomes, neurodevelopmental disorders and mental health disorders in patients with intestinal atresia (IA) and compare these to outcomes to age-matched controls. METHODS We performed a retrospective case-control study of children with IA born between 1991 and 2017. We evaluated educational outcomes using an Early Developmental Instrument, Grades 3, 7 and 8 assessments, Grade 9 completion and performance, high school graduation, and neurodevelopmental and mental health disorders using International Classification of Diseases codes available from a population-based dataset. RESULTS We identified a total of 94 IA cases and 940 date-of-birth-matched controls. Cases with chromosomal anomalies were more likely to fail the Early Developmental Instrument (OR = 2.88, p = 0.037), Grade 8 reading (OR = 2.94, p = 0.043) and Grade 12 (OR = 3.25, p = 0.036); cases without chromosomal anomalies were at no greater risk than their peers of failing to meet expectations and did not have an increased risk of anxiety (OR = 0.48, p = 0.12), depression (OR = 0.74, p = 0.6) or hyperactivity disorder (OR = 1.92, p = 0.087). CONCLUSIONS Our study demonstrated that IA patients without chromosomal anomalies are not at higher risk of neurodevelopmental and mental health disorders than controls. These results will offer more accurate outcome predictions for parents of children with IA.
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Affiliation(s)
- Yuichiro Miyake
- Department of Surgery, Division of Pediatric Surgery, University of Manitoba, and Children's Hospital Research Institute of Manitoba, AE402-820 Sherbrook Street, Winnipeg, MB, R3A 1S1, Canada.,Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Suyin A Lum Min
- Department of Surgery, Division of Pediatric Surgery, University of Manitoba, and Children's Hospital Research Institute of Manitoba, AE402-820 Sherbrook Street, Winnipeg, MB, R3A 1S1, Canada
| | - Atsuyuki Yamataka
- Department of Pediatric General and Urogenital Surgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Richard Keijzer
- Department of Surgery, Division of Pediatric Surgery, University of Manitoba, and Children's Hospital Research Institute of Manitoba, AE402-820 Sherbrook Street, Winnipeg, MB, R3A 1S1, Canada.
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Educational and mental health outcomes in school-aged children with anorectal malformations: A case-control cohort study. J Pediatr Surg 2023; 58:844-848. [PMID: 36805139 DOI: 10.1016/j.jpedsurg.2023.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 01/03/2023] [Indexed: 01/20/2023]
Abstract
PURPOSE Outcome studies for patients with anorectal malformation (ARM) have focused on fecal incontinence and quality of life, but a comparison of educational outcomes between ARM cases and controls has not been reported. The purpose of this study was to assess real-world educational outcomes, neurodevelopmental disorders and mental health disorders in ARM patients and compare to an age-matched control group. METHODS We performed a retrospective case-control study of children diagnosed with ARM from 1991 to 2017. We evaluated educational outcomes using an Early Developmental Instrument, Grades 3, 7, and 8 assessments, Grade 9 completion and performance, and high school graduation. Neurodevelopmental and mental health disorders were compared using International Classification of Diseases codes available from a population-based dataset. RESULTS A total of 96 ARM cases and 960 controls were identified. Cases were at greater risk of failing to meet expectations on Grades 7 and 8 assessments. After entering high school, ARM patients were at no greater risk than their peers of failing to meet expectations. Cases were more likely to have a developmental or intellectual disability (OR 3.59, p < 0.001), anxiety (OR 1.86, p = 0.023), depression (OR 2.35, p = 0.022) or hyperactivity disorder (OR 2.01, p = 0.036). CONCLUSIONS Our study demonstrated that ARM patients may be more likely to perform poorly in junior high school than controls and may be at greater risk of neurodevelopmental and mental health disorders. It is important for pediatric surgeons to anticipate these challenges and endorse psychosocial supports to optimize educational and mental health outcomes. LEVELS OF EVIDENCE Level-Ⅲ.
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Oltean I, Hayawi L, Larocca V, Bijelić V, Beveridge E, Kaur M, Grandpierre V, Kanyinda J, Nasr A. Quality of life outcomes in children after surgery for Hirschsprung disease and anorectal malformations: a systematic review and meta-analysis. WORLD JOURNAL OF PEDIATRIC SURGERY 2022; 5:e000447. [DOI: 10.1136/wjps-2022-000447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 10/12/2022] [Indexed: 11/12/2022] Open
Abstract
BackgroundNo systematic review and meta-analysis to date has examined multiple child and parent-reported social and physical quality of life (QoL) in pediatric populations affected by Hirschsprung’s disease (HD) and anorectal malformations (ARM). The objective of this systematic review is to quantitatively summarize the parent-reported and child-reported psychosocial and physical functioning scores of such children.MethodsRecords were sourced from the CENTRAL, EMBASE, and MEDLINE databases. Studies that reported child and parent reported QoL in children with HD and ARM, regardless of surgery intervention, versus children without HD and ARM, were included. The primary outcome was the psychosocial functioning scores, and the secondary outcomes were the presence of postoperative constipation, postoperative obstruction symptoms, fecal incontinence, and enterocolitis. A random effects meta-analysis was used.ResultsTwenty-three studies were included in the systematic review, with 11 studies included in the meta-analysis. Totally, 1678 total pediatric patients with HD and ARM underwent surgery vs 392 healthy controls. Pooled parent-reported standardized mean (SM) scores showed better social functioning after surgery (SM 91.79, 95% CI (80.3 to 103.3), I2=0). The pooled standardized mean difference (SMD) showed evidence for parent-reported incontinence but not for constipation in children with HD and ARM after surgery that had a lower mean QoL score compared with the normal population (SMD −1.24 (-1.79 to –0.69), I2=76% and SMD −0.45, 95% CI (−1.12 to 0.21), I2=75%). The pooled prevalence of child-reported constipation was 22% (95% CI (16% to 28%), I2=0%). The pooled prevalence of parent-reported postoperative obstruction symptoms was 61% (95% CI (41% to 81%), I2=41%).ConclusionThe results demonstrate better social functioning after surgery, lower QoL scores for incontinence versus controls, and remaining constipation and postoperative obstruction symptoms after surgery in children with HD and ARM.
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Scirè G, Gabaldo R, Dando I, Camoglio FS, Zampieri N. Quality of Life and Anorectal Malformations: A Single-Center Experience. Pediatr Gastroenterol Hepatol Nutr 2022; 25:340-346. [PMID: 35903487 PMCID: PMC9284112 DOI: 10.5223/pghn.2022.25.4.340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/06/2022] [Accepted: 05/02/2022] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The treatment and long term clinical outcomes of anorectal malformations (ARM) in children have always been the focus of pediatric surgeons. This study aimed at reporting our experience as far as long-term follow-up of ARM in children is concern. METHODS We enrolled patients treated between 1999 and 2019, and established selection criteria to choose appropriate subjects. A validated questionnaire was used to determine long-term quality of life outcomes. RESULTS Out of a total of 48 patients treated within the study period, 28 were enrolled in this study. Among the latter, more than 35% had at least one long-time complication, and more than 90% had a good lifestyle. Urinary and fecal continence was achieved in more than 95% of the patients using medical devices. CONCLUSION This study aimed to bring up new concepts; taking into consideration all aspects of life in patients with ARM, from school life to sexuality, while evaluating fecal and urinary continence. This is essential for the improvement of the skills of the different specialists involved in the management of these patients, and for the implementation of strategies that can improve postoperative function. Most especially, it will also help improve communication between doctors to ensure an adequate transition of these children into adult life.
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Affiliation(s)
- Gabriella Scirè
- Division of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics, and Gynecology, Pediatric Fertility Lab, Women & Child Hospital, University of Verona, Piazzale Stefani, Verona, Italy
| | - Riccardo Gabaldo
- Division of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics, and Gynecology, Pediatric Fertility Lab, Women & Child Hospital, University of Verona, Piazzale Stefani, Verona, Italy
| | - Ilaria Dando
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Francesco S Camoglio
- Division of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics, and Gynecology, Pediatric Fertility Lab, Women & Child Hospital, University of Verona, Piazzale Stefani, Verona, Italy
| | - Nicola Zampieri
- Division of Pediatric Surgery, Department of Surgery, Dentistry, Pediatrics, and Gynecology, Pediatric Fertility Lab, Women & Child Hospital, University of Verona, Piazzale Stefani, Verona, Italy
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Svetanoff WJ, Kapalu CL, Lopez JJ, Fraser JA, Briggs KB, Rentea RM. Psychosocial factors affecting quality of life in patients with anorectal malformation and Hirschsprung disease-a qualitative systematic review. J Pediatr Surg 2022; 57:387-393. [PMID: 34127258 DOI: 10.1016/j.jpedsurg.2021.05.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/07/2021] [Accepted: 05/02/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Little is known about psychosocial and behavioral factors that impact the quality of life of patient's with anorectal malformations (ARM) and Hirschsprung disease (HSCR). We aimed to highlight the psychosocial, emotional, and behavioral themes that affect these patients. METHODS A qualitative literature review of articles published between 1980 and 2019 was performed. Articles that reported quality of life (QoL) measures not directly related to bowel function and incorporated data on patients aged 0-21 years old were included. Data were separated based on distinct developmental time points. RESULTS In the neonatal period, parents relayed uncertainty about the future and feeling overwhelmed by lack of social support. Difficulties with anxiety, peer rejection, and behavioral problems were noted in primary grades, while adolescents experienced low self-confidence, poor body image, and depression. Young adults expressed hesitancy to engage in romantic relationships or sexual activity. Lack of long-term follow-up, an incomplete transition to adult healthcare, and lack of psychology services leave young adults without guidance to manage a chronic condition. CONCLUSION Multiple psychosocial stressors are present in the lives of ARM and HSCR patients. Provision of developmentally matched medical, psychological, and community-based supports for ARM and HSCR patients and their families can lead to improved QoL.
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Affiliation(s)
- Wendy Jo Svetanoff
- Comprehensive Colorectal Center, Children's Mercy-Kansas City, Kansas City, MO, United States; Department of Surgery, Children's Mercy Hospital Kansas City, MO, United States
| | - Christina Low Kapalu
- Comprehensive Colorectal Center, Children's Mercy-Kansas City, Kansas City, MO, United States; Department of Gastroenterology, Hepatology, and Nutrition, Children's Mercy Hospital Kansas City, MO, United States; University of Missouri-Kansas City School of Medicine, United States
| | - Joseph J Lopez
- Comprehensive Colorectal Center, Children's Mercy-Kansas City, Kansas City, MO, United States; Department of Surgery, Children's Mercy Hospital Kansas City, MO, United States
| | - James A Fraser
- Comprehensive Colorectal Center, Children's Mercy-Kansas City, Kansas City, MO, United States; Department of Surgery, Children's Mercy Hospital Kansas City, MO, United States
| | - Kayla B Briggs
- Comprehensive Colorectal Center, Children's Mercy-Kansas City, Kansas City, MO, United States; Department of Surgery, Children's Mercy Hospital Kansas City, MO, United States
| | - Rebecca M Rentea
- Comprehensive Colorectal Center, Children's Mercy-Kansas City, Kansas City, MO, United States; Department of Surgery, Children's Mercy Hospital Kansas City, MO, United States; University of Missouri-Kansas City School of Medicine, United States.
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Rollins MD, Bucher BT, Wheeler JC, Horns JJ, Paudel N, Hotaling JM. Healthcare Burden and Cost in Children with Anorectal Malformation During the First 5 Years of Life. J Pediatr 2022; 240:122-128.e2. [PMID: 34487770 DOI: 10.1016/j.jpeds.2021.08.083] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To identify cumulative 5-year healthcare costs and healthcare days in children with anorectal malformation (ARM) and to compare the cumulative 5-year healthcare costs and healthcare days in children with ARM with 3 control cohorts: healthy, premature, and congenital heart disease (CHD). STUDY DESIGN We performed a retrospective case-control study using the Truven MarketScan database of commercial claims encounters between 2008 and 2017. The ARM, CHD, and premature cohorts were identified using a targeted list of International Classification of Diseases 9th or 10th Revision diagnosis and Current Procedural Terminology codes. The healthy cohort included patients without ARM, preterm birth, or CHD. RESULTS We identified 664 children with ARM, 3356 children with heart disease, 63 190 children who were born preterm, and 2947 healthy patients. At 5 years, the total healthcare costs of children with ARM ($273K, 95% CI $168K-$378K) were similar to the premature cohort ($246K, 95% CI $237K-$255K) and lower than the CHD cohort ($466K, 95% CI $401K-$530K, P < .001). Total healthcare days were similar in children with ARM (158 days, 95% CI 117-198) and prematurity (141 days, 95% CI 137-144) but lower than CHD (223 days, 95% CI 197-250, P = .02). In ARM, outpatient care (126 days, 95% CI 93-159) represented the largest contribution to total healthcare days. CONCLUSIONS Children with ARM accumulate similar healthcare costs to children with prematurity and comparable healthcare days to children with CHD and prematurity in the first 5 years of life. Outpatient care represents the majority of healthcare days in children with ARM, identifying this as a target for quality improvement and demonstrating the long-term impact of this condition.
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Affiliation(s)
- Michael D Rollins
- Division of Pediatric Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT.
| | - Brian T Bucher
- Division of Pediatric Surgery, Department of Surgery, University of Utah Health, Salt Lake City, UT
| | - Justin C Wheeler
- Division of Pediatric Gastroenterology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT
| | - Joshua J Horns
- Department of Surgery, University of Utah Health, Salt Lake City, UT
| | - Niraj Paudel
- Department of Surgery, University of Utah Health, Salt Lake City, UT
| | - James M Hotaling
- Division of Urology, Department of Surgery, University of Utah Health, Salt Lake City, UT
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Stathopoulos E, Skerritt C, Fitzpatrick G, Hooker E, Lander A, Gee O, Jester I. Children with congenital colorectal malformations during the UK Sars-CoV-2 pandemic lockdown: an assessment of telemedicine and impact on health. Pediatr Surg Int 2021; 37:1593-1599. [PMID: 34351444 PMCID: PMC8340806 DOI: 10.1007/s00383-021-04971-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 11/05/2022]
Abstract
PURPOSE This pilot study was designed to assess bowel function and quality of life (QoL) in children and adolescents with congenital colorectal malformations (CCM) during the first UK COVID lockdown period. METHODS Changes in health were assessed through semi-structured interviews, gastrointestinal functional outcomes using Krickenbeck scoring and QoL by the modified disease-specific HAQL (Hirschsprung's disease anorectal malformation quality of life questionnaire). The State-Trait Anxiety Inventory (STAI)™ for adults was used to assess parental anxiety. RESULTS Thirty-two families were interviewed; 19 (59%) reported no change in their child's health during the lockdown, 5 (16%) a deterioration and 8 (25%) an improvement. Neither the severity of the CCM, nor the degree of bowel dysfunction, correlated with any deterioration. The HAQL score was not correlated to a change in health. Anxiety scores ranged from no anxiety to clinical concerns. Telemedicine was well accepted by 28/32 parents (88%); however, in-person appointments were preferred if there were clinical concerns. CONCLUSION In the follow-up of children and adolescents with CCM during the first UK lockdown using telemedicine we found that over half had stable health conditions. Patients needing additional care could not be predicted by the severity of their disease or their bowel function alone.
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Affiliation(s)
- E. Stathopoulos
- grid.415246.00000 0004 0399 7272Department of Paediatric Surgery, Birmingham Women’s and Children’s Hospital, Steelhouse Lane, Birmingham, UK
| | - C. Skerritt
- grid.415246.00000 0004 0399 7272Department of Paediatric Surgery, Birmingham Women’s and Children’s Hospital, Steelhouse Lane, Birmingham, UK
| | - G. Fitzpatrick
- grid.415246.00000 0004 0399 7272Department of Paediatric Surgery, Birmingham Women’s and Children’s Hospital, Steelhouse Lane, Birmingham, UK
| | - E. Hooker
- grid.415246.00000 0004 0399 7272Department of Paediatric Surgery, Birmingham Women’s and Children’s Hospital, Steelhouse Lane, Birmingham, UK
| | - A. Lander
- grid.415246.00000 0004 0399 7272Department of Paediatric Surgery, Birmingham Women’s and Children’s Hospital, Steelhouse Lane, Birmingham, UK
| | - O. Gee
- grid.415246.00000 0004 0399 7272Department of Paediatric Surgery, Birmingham Women’s and Children’s Hospital, Steelhouse Lane, Birmingham, UK
| | - I. Jester
- grid.415246.00000 0004 0399 7272Department of Paediatric Surgery, Birmingham Women’s and Children’s Hospital, Steelhouse Lane, Birmingham, UK
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11
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Nash O, Zobell S, Worst K, Rollins MD. Bowel management for the treatment of fecal incontinence and constipation in patients with anorectal malformations. Semin Pediatr Surg 2020; 29:150993. [PMID: 33288134 DOI: 10.1016/j.sempedsurg.2020.150993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Onnalisa Nash
- Nationwide Children's Hospital, Columbus, OH, United States.
| | - Sarah Zobell
- Primary Children's Hospital, Salt Lake City, UT, United States
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Baxter KJ, Garza JM, Rollins MD, Drake K, Reeder RW, Wood R, Avansino J, Calkins CM, Ralls M, Garvey EM, Durham MM. Multi-institutional review of bowel management strategies in children with anorectal malformations. J Pediatr Surg 2020; 55:2752-2757. [PMID: 32616413 DOI: 10.1016/j.jpedsurg.2020.04.023] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/23/2020] [Accepted: 04/29/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND/RATIONALE To describe current bowel management program (BMP) strategies in anorectal malformation (ARM) patients based on patient-level predictors using data from a multi-institutional consortium. MATERIALS/METHODS Patient bowel function and BMP were reviewed from Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) data. The PCPLC is comprised of multidisciplinary specialists researching colorectal and pelvic disorders. Seven US institutions submitted de-identified clinical data on ARM patients into a centralized patient registry. RESULTS The primary ARM of 624 patients was categorized into Mild (45.2%), Moderate (40.4%) or Complex (14.2%) anomaly classifications. Patient-specific BMP were examined based on age and on the presence of spinal cord/sacral anomalies. 418 (67%) enrolled patients were prescribed BMP (<5 yo 56.4%; ≥5-<12 yo 86.7%; ≥12 81.5%). Constipation was the primary chief complaint (80.2%). Forty percent of patients on a BMP were toilet trained and approximately one-half (48.5%) reported daytime stool accidents. Secondary surgical interventions for antegrade continence enemas (ACE) were examined; 14.5% of patients employed ACE strategies and utilization increased with age and varied based on anatomic anomalies. CONCLUSIONS This is the first report on BMP strategies for patients with ARM from the Pediatric Colorectal and Pelvic Learning Consortium. Individual patient characteristics are explored for their impact on bowel management strategy utilization. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Katherine J Baxter
- Emory University School of Medicine, Office of Surgical Education, H100 Emory University Hospital1364 Clifton Road, NE, Atlanta, GA 30322, USA
| | - Jose M Garza
- Children's Healthcare of Atlanta, 1400 Tullie Road NE 6th Floor, Atlanta, GA 30329, USA
| | - Michael D Rollins
- Primary Children's Hospital, University of Utah, 100 N. Mario Capecchi Drive, Salt Lake City, UT 84113, USA
| | - Kaylea Drake
- Data Coordinating Center, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Ron W Reeder
- Data Coordinating Center, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Richard Wood
- Nationwide Children's Hospital, 700 Children's Drive Columbus, OH 43205, USA
| | - Jeffrey Avansino
- Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, Washington 98105, USA
| | - Casey M Calkins
- Children's Hospital of Wisconsin, 999 N. 92(nd) Street, Milwaukee, WI 53226, USA
| | - Matt Ralls
- University of Michigan, 1540 E. Hospital Drive, Ann Arbor, MI 48109, USA
| | - Erin M Garvey
- Phoenix Children's Hospital , 1919 E. Thomas Road, Phoenix, AZ 85106, USA
| | - Megan M Durham
- Division of Pediatric Surgery, Emory University School of Medicine and Children's Healthcare of Atlanta, 1405 Clifton Road NE, 3rd Floor, Tower 1, Pediatric Surgical Suite, Atlanta, Ga 30322, USA.
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Li J, Gao W, Zuo W, Liu X. Relationship Between Quality of Life and Social Support in Parents of Children with Congenital Anorectal Malformations in China. J Pediatr Nurs 2020; 53:e87-e92. [PMID: 32147275 DOI: 10.1016/j.pedn.2020.02.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE This study aimed to explore the quality of life (QOL) and social support of parents of children with congenital anorectal malformation (ARM), and to examine the relationship between them. DESIGN AND METHODS A cross-sectional study was conducted at Anhui Provincial Children's Hospital of China from January to June of 2018. A total of 108 parents participated in this survey. QOL and social support were accessed using the short version of the World Health Organization's Quality of Life Instrument (WHOQOL-BREF) and the Social Support Rate Scale (SSRS), respectively. Analyses were performed with multivariate linear regression and canonical correlation. RESULTS The parents' scores in the physical, psychological, and environmental domains were lower than those in the general population in China. Gender, monthly income, combined malformation, objective support, subjective support and utilization of support were the major influencing factors of QOL. A canonical correlation analysis indicated social support was positively correlated with QOL, and subjective support, psychological domain had the largest standardized factor loading in social support and QOL. CONCLUSIONS The QOL of parents of ARM patients was not optimistic. More attention needs to be paid to increasing social support for the parents of ARM to enhance their QOL. PRACTICE IMPLICATIONS For government, increasing funds and resources to invest in the establishment and improvement of the social support network is necessary. For doctors and nurses, providing better medical and psychological services to patients and their parents is essential.
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Affiliation(s)
- Jing Li
- Department of Public Health and General Medicine, Anhui University of Chinese Medicine, China
| | - Wei Gao
- Department of Pediatric Surgery, Anhui Provincial Children's Hospital, China
| | - Wei Zuo
- Department of Pediatric Surgery, Anhui Provincial Children's Hospital, China
| | - Xiang Liu
- Department of Pediatric Surgery, Anhui Provincial Children's Hospital, China.
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Quality of life in children with pseudoincontinence after implementing a bowel management program in Egypt. J Pediatr Surg 2020; 55:261-264. [PMID: 31918852 DOI: 10.1016/j.jpedsurg.2019.10.048] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 10/26/2019] [Indexed: 12/14/2022]
Abstract
AIM OF THE STUDY The aim of this study was to evaluate the impact of implementing a Bowel Management Program (BMP) on the quality of life (QOL) in children with pseudoincontinence. METHOD Children aged 2.5-13 years with pseudoincontinence were included. Evaluations were performed before and after BMP implementation. Perceptions from parents about QOL were assessed by a QOL questionnaire, and the severity of fecal incontinence (FI) was assessed using the fecal incontinence index (FII) of the Wexner scale. RESULTS 115 children (mean age of 7.54 ± 2.48) were studied over a 3-12 month period (mean duration 4.36 months). QOL improved from 2.45 ± 1.57 to 14.36 ± 1.37, P˂0.05. There was a significant improvement of the FII: 18.65 ± 1.25 versus 0.13 ± 0.39, P˂ 0.05. There was a significant inverse correlation between the final scores of QOL (14.36 ± 1.37) and FII (0.13 ± 0.39) after implementation of the BMP (r = -0.53; P ˂ 0.05). CONCLUSION This is the largest case series examining QOL in pseudoincontinent children. It demonstrates that BMP significantly improves the QOL of these children in the short and midterm. In addition, it is feasible to apply the FII in assessing incontinence in children. To our knowledge, this is the first study of its kind in our region. LEVEL OF EVIDENCE Level IV.
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Chang PCY, Duh YC, Fu YW, Hsu YJ, Wei CH, Huang H. How much do we know about constipation after surgery for anorectal malformation? Pediatr Neonatol 2020; 61:58-62. [PMID: 31296400 DOI: 10.1016/j.pedneo.2019.05.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/11/2019] [Accepted: 05/30/2019] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND To evaluate the occurrence of constipation after anorectal malformations (ARM) repair and the results of laxative treatment. METHODS Between August 2012 and July 2017, the clinical data of patients with ARMs was prospectively collected. The patients were divided into two groups, good types and poor types. Good types included rectoperineal, rectovestibular, rectourethral bulbar, and no fistula. Risk factors were defined as spinal cord anomalies, sacral ratio <0.4, or cognitive impairment. Success was defined as that laxative could be tapered. RESULTS Eighty-four patients were enrolled with mean age of 6.3 ± 7.8 (0.6-59.9) years. The mean age of onset of constipation was 12.8 ± 8.3 months and the mean interval was 5.9 ± 5.1 months after reconstructions. The interval was not significantly different between patients with good types and poor types. In 23 patients with severe constipation being treated for >6 months, 14 of 18 (77.8%) patients with good types were classified as success, whereas only 1 of 5 (20%) patients with poor types was (p = 0.02). In patients with good types, 9 of 9 (100%) patients with no risk factors were successful; however, only 5 out of 9 (55.6%) patients with risk factors were successful (p = 0.02). CONCLUSION Constipation occurs shortly after operations. Patients with good types and no risk factors are susceptible to weaning laxatives.
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Affiliation(s)
- Paul Chia-Yu Chang
- Division of Pediatric Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan; School of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Yih-Cherng Duh
- Division of Pediatric Surgery, Department of Surgery, Mackay Memorial Hospital, Hsinchu, Taiwan
| | - Yu-Wei Fu
- Department of Pediatric Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Yao-Jen Hsu
- Department of Pediatric Surgery, Changhua Christian Hospital, Changhua, Taiwan
| | - Chin-Hung Wei
- Division of Pediatric Surgery, Department of Surgery, Shuang Ho Hospital, New Taipei City, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Hsuan Huang
- Division of Pediatric Surgery, Department of Surgery, Mackay Memorial Hospital, Taipei, Taiwan
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Hutson JM, Hynes MC, Kearsey I, Yik YI, Veysey DM, Tudball CF, Cain TM, King SK, Southwell BR. 'Rapid transit' constipation in children: a possible genesis for irritable bowel syndrome. Pediatr Surg Int 2020; 36:11-19. [PMID: 31673760 DOI: 10.1007/s00383-019-04587-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/03/2019] [Indexed: 02/07/2023]
Abstract
Children with chronic idiopathic constipation (CIC) often end up at the surgeon when medical treatments have failed. This opinion piece discusses a recently described pattern of CIC called 'Rapid transit constipation (RTC)' first identified in 2011 as part of surgical workup. RTC was identified using a nuclear medicine gastrointestinal transit study (NMGIT or nuclear transit study) to determine the site of slowing within the bowel and to inform surgical treatment. Unexpectedly, we found that RTC occured in 29% of 1000 transit studies in a retrospective audit. Irritable bowel syndrome (IBS) occurs in 7-21% of the population, with a higher prevalence in young children and with constipation type dominating in the young. While 60% improve with time, 40% continue with symptoms. First-line therapy for IBS in adults is a diet low in fermentable oligosaccharides, disaccharides, monosaccharides and polyols which reduces symptoms in > 70% of patients. In children with functional gastrointestinal disorders, fructose intolerance occurs in 35-55%. Reducing fructose produced significant improvement in 77-82% of intolerant patients. In children with RTC and a positive breath test upon fructose challenge, we found that exclusion of fructose significantly improved constipation, abdominal pain, stool consistency and decreased laxative use. We hypothesise that positive breath tests and improvement of pain and bowel frequency with sugar exclusion diets in RTC suggest these children have IBS-C. These observations raise the possibility that many children with CIC could be treated by reducing fructose early in their diet and this might prevent the development of IBS in later life.
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Affiliation(s)
- J M Hutson
- Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia. .,Department of Urology, The Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, Australia. .,Department of Paediatrics, University of Melbourne, Melbourne, Australia.
| | - M C Hynes
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - I Kearsey
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Y I Yik
- Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Division of Paediatric and Neonatal Surgery, Department of Surgery, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - D M Veysey
- Department of Nuclear Medicine, The Royal Children's Hospital, Melbourne, Australia
| | - C F Tudball
- Department of Nuclear Medicine, The Royal Children's Hospital, Melbourne, Australia
| | - T M Cain
- Department of Nuclear Medicine, The Royal Children's Hospital, Melbourne, Australia
| | - S K King
- Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Australia.,Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, Melbourne, Australia
| | - B R Southwell
- Surgical Research Group, Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
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Zheng H, Liu G, Liang Z, Chen Y, Wen Z, Yu J, Xu X, Liang H, Wang Y. Middle-term bowel function and quality of life in low-type anorectal malformation. Ital J Pediatr 2019; 45:98. [PMID: 31409364 PMCID: PMC6693156 DOI: 10.1186/s13052-019-0701-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 08/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low-type anorectal malformations (ARMs) are considered benign; however, in China, data regarding such conditions are limited. Thus, this study aimed to assess the middle-term bowel functions and quality of life (QOL) among children with low-type ARM. METHODS Children > 3 years of age who underwent treatment for low-type ARM (vestibular fistula [VF] and perineal fistula [PF]) during 2013 and healthy children were included. The children were interviewed during their outpatient visits. The primary outcome measures were bowel function, as assessed using the Baylor Continence Scale (BCS), and QOL, as measured using the Pediatric Quality of Life Inventory (PedsQL 4.0). RESULTS A total of 82 patients responded; mean patient age was 6.8 (range, 3-12) years. Mean BCS score in the control group (7.94 ± 4.74) was significantly lower than that in the VF (18.69 ± 11.11, P < 0.001) and PF (15.47 ± 6.50, P < 0.001) groups. However, there were no differences in PedsQL 4.0 scores among the groups. The patients scored the lowest for emotional function and the highest for physical function. Nearly all measurements of QOL significantly decreased with increased BCS score. CONCLUSIONS Children with low-type ARM can achieve good bowel control and QOL. However, although ARMs are benign, several children with this condition suffer from anal function problems that affect QOL. Redo operations, mislocated anus, and incorrect constipation treatment are the iatrogenic causes of fecal incontinence.
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Affiliation(s)
- Haiqing Zheng
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Guangjian Liu
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zijian Liang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
| | - Yunpei Chen
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
| | - Zhe Wen
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
| | - Jiakang Yu
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
| | - Xiaogang Xu
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China
| | - Huiying Liang
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yong Wang
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, 9 Jinsui Road, Guangzhou, 510623, China.
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Reeder RW, Wood RJ, Avansino JR, Levitt MA, Durham MM, Sutcliffe J, Midrio P, Calkins CM, de Blaauw I, Dickie BH, Rollins MD. The Pediatric Colorectal and Pelvic Learning Consortium (PCPLC): rationale, infrastructure, and initial steps. Tech Coloproctol 2018; 22:395-399. [DOI: 10.1007/s10151-018-1782-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 03/13/2018] [Indexed: 12/29/2022]
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Diseth TH, Emblem R. Long-term psychosocial consequences of surgical congenital malformations. Semin Pediatr Surg 2017; 26:286-294. [PMID: 29110824 DOI: 10.1053/j.sempedsurg.2017.09.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Surgical congenital malformations often represent years of treatment, large number of hospital stays, treatment procedures, and long-term functional sequels affecting patients' psychosocial functioning. Both functional defects and psychosocial difficulties that occur commonly in childhood may pass through adolescence on to adulthood. This overview presents reports published over the past 3 decades to elucidate the long-term psychosocial consequences of surgical congenital malformations. Literature searches conducted on PubMed database revealed that less than 1% of all the records of surgical congenital malformations described long-term psychosocial consequences, but with diverse findings. This inconsistency may be due to methodological differences or deficiencies; especially in study design, patient sampling, and methods. Most of the studies revealed that the functional deficits may have great impact on patients' mental health, psychosocial functioning, and QoL; both short- and long-term negative consequences. Factors other than functional problems, e.g., repeated anesthesia, multiple hospitalization, traumatic treatment procedures, and parental dysfunctioning, may also predict long-term mental health and psychosocial functioning. Through multidisciplinary approach, pediatric surgeons should also be aware of deficits in emotional and psychosocial functioning. To achieve overall optimal psychosocial functioning, the challenge is to find a compromise between physically optimal treatment procedures and procedures that are not psychologically detrimental.
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Affiliation(s)
- Trond H Diseth
- Section for Psychosomatics and CL-child Psychiatry, Department of Clinical Neurosciences for Children, Division of Paediatric and Adolescent Medicine, Oslo University Hospital Rikshospitalet, Pb 4950 Nydalen, N-0424 Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Ragnhild Emblem
- Department of Paediatric Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Kyrklund K, Pakarinen MP, Rintala RJ. Long-term bowel function, quality of life and sexual function in patients with anorectal malformations treated during the PSARP era. Semin Pediatr Surg 2017; 26:336-342. [PMID: 29110831 DOI: 10.1053/j.sempedsurg.2017.09.010] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Anorectal malformations are an important group of congenital anomalies that vary widely in their anatomical characteristics and complexity. Understanding the long-term functional outcomes after modern treatments, and how these compare to the general population, are essential for ensuring that patients receive optimal, evidence-based care. With increasing appreciation of the wider impact of the illness on patients and their families, minimizing social disability from fecal incontinence and enabling normal social integration from the outset are key management concerns. This review summarizes the current knowledge on the functional outcomes by type of malformation, reflecting on the literature, and our institutional experience over a follow-up period of nearly 30 years.
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Affiliation(s)
- Kristiina Kyrklund
- Department of Pediatric Surgery, Children's Hospital, Helsinki University Central Hospital, P O Box 281, FIN-00029 HUS, Finland
| | - Mikko P Pakarinen
- Department of Pediatric Surgery, Children's Hospital, Helsinki University Central Hospital, P O Box 281, FIN-00029 HUS, Finland
| | - Risto J Rintala
- Department of Pediatric Surgery, Children's Hospital, Helsinki University Central Hospital, P O Box 281, FIN-00029 HUS, Finland.
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Wang Y, Liang H, Wu Q, Zheng H, Liu G, Wen Z, Lan M, Yu J, Zhu D, Liang J, Zhang J, Xu X, Xia H. Bowel management program for pediatric postoperative fecal incontinence in China: A surgeon's experience. Medicine (Baltimore) 2017; 96:e7078. [PMID: 28562577 PMCID: PMC5459742 DOI: 10.1097/md.0000000000007078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of this article is to report the status of the efficacy of and long-term adherence to the Bowel Management Program (BMP) for fecal incontinence (FI) postoperation in China.Children over 3 years of age with FI postoperation referred to our medical center were included in the study. Evaluations were performed before and 2 years after their clinic visit. The cost of bowel care, improvement in incontinence, health-related quality of life, and family functioning with the BMP were analyzed.A total of 48 children with FI were included in our study, of whom 38 were boys. The median treatment fee was 660.1 dollars. The complications included abdominal pain (4 patients, 8%), occasional vomiting (2 patients, 4%), and hypoglycemia (1 patient, 2%). The incontinence status and health-related quality of life improved significantly after the BMP. Despite the good outcome of the BMP, half of the patients discontinued the program.The BMP is an effective approach to manage FI and improve the patients' quality of life. Poor long-term adherence is currently the main challenge affecting the BMP application in China.
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Affiliation(s)
- Yong Wang
- Southern Medical University
- Department of Pediatric Surgery
| | - Huiying Liang
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | | | - Haiqing Zheng
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Guangjian Liu
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zhe Wen
- Department of Pediatric Surgery
| | | | | | | | | | | | | | - Huimin Xia
- Southern Medical University
- Department of Pediatric Surgery
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Reply by Authors. J Urol 2017; 197:1364-1365. [DOI: 10.1016/j.juro.2016.12.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Determinants of quality of life in children with colorectal diseases. J Pediatr Surg 2016; 51:1843-1850. [PMID: 27586859 DOI: 10.1016/j.jpedsurg.2016.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 08/02/2016] [Accepted: 08/04/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND Health related Quality of Life (HRQoL) is an important outcome in medical care. The aim of our study was to identify characteristics associated with lower HRQoL scores in children with anorectal malformation (ARM) and Hirschsprung disease (HD). METHODS Patients younger than 18years, with HD or ARM, who were evaluated at our center from April 2014 to August 2015, were identified. The results of comprehensive questionnaires regarding diagnosis, symptoms, comorbidities and previous medical/surgical history, and validated tools to assess urinary status, stooling status and HRQoL were evaluated. RESULTS In children aged 0-4years, vomiting and abdominal distension were found to be associated with a significant reduction in total HRQoL scores. In children >4years of age, vomiting, nausea, abdominal distension, and abdominal pain were also associated with a significantly lower HRQoL. The strongest predictor of lower HRQoL scores on regression tree analysis, in all age groups, was the presence of a psychological, behavioral or developmental comorbidity. CONCLUSION Patients with either HD or an ARM who have a psychological, behavioral or developmental problem experience significantly lower HRQoL than children without such problems, suggesting that provision of behavioral/developmental support as part of the multidisciplinary care of these children may have a substantial impact on their HRQoL.
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Colares JHF, Purcaru M, da Silva GPF, Frota MA, da Silva CAB, Melo-Filho AA, Bischoff A, Peña A. Impact of the Bowel Management Program on the quality of life in children with fecal incontinence. Pediatr Surg Int 2016; 32:471-6. [PMID: 26875175 DOI: 10.1007/s00383-016-3874-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Evaluate the impact of implementing Bowel Management Program (BMP) on quality of life (QoL) in children with fecal incontinence (FI). METHODS Children 3-12 years referred to the Children's Treatment Center of FI were included and categorized accordingto the tendency to constipation (dilated colon; group 1) or diarrhea (non-dilated colon; group 2). Evaluations were performed before and after 3 months of BMP implementation. Perceptions from parents and children about QoL were assessed by the instrument PedsQL4.0 and the severity of FI by the fecal incontinence index (FII) of Wexner scale. RESULTS 43 children (mean age of 7.7 ± 3.1) were studied. 32 (74.4 %) belonged to group 1 and 11 (25.6 %) to group 2. After 3 months of BMP, it was noticed a significant improvement of the FII (14.5 ± 3.7 versus 2.8 ± 2.5; p < 0.001) in both groups. QoL perception by the parents and children increased on PedsQL4.0 evaluation (p < 0.001). There was a medium inverse statistically significant correlation of the FII and the total PedsQL4.0 score among children and parents (r = -0.47, p = 0.009 and r = -0, 39, p = 0.03, respectively). CONCLUSION The BMP applied by a multidisciplinary dedicated team significantly improves the QoL of children with FI in the short-term period.
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Affiliation(s)
- João H F Colares
- Pediatric Surgery Section, Albert Sabin Pediatric Hospital (HIAS), Tertuliano Sales, 544-Vila União, Fortaleza, Ceará, CEP: 60430-230, Brazil.
| | - Marionescu Purcaru
- Nursing Department, Albert Sabin Pediatric Hospital (HIAS), Fortaleza, Ceará, Brazil
| | | | - Mirna A Frota
- Master's Department in Public Health, University of Fortaleza (UNIFOR), Fortaleza, Ceará, Brazil
| | - Carlos A B da Silva
- Master's Department in Public Health, University of Fortaleza (UNIFOR), Fortaleza, Ceará, Brazil
| | - Antônio A Melo-Filho
- Pediatric Surgery Section, Albert Sabin Pediatric Hospital (HIAS), Tertuliano Sales, 544-Vila União, Fortaleza, Ceará, CEP: 60430-230, Brazil
- Department of Surgery, Medical School, Federal University of Ceará (UFC), Fortaleza, Ceará, Brazil
| | - Andrea Bischoff
- Division of Pediatric Surgery, Colorectal Center for Children, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
| | - Alberto Peña
- Division of Pediatric Surgery, Colorectal Center for Children, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, 45229, USA
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Mathias AL, Tannuri ACA, Ferreira MAE, Santos MM, Tannuri U. Validação de questionários para avaliação da qualidade de vida relacionada à continência fecal em crianças com malformações anorretais e doença de Hirschsprung. REVISTA PAULISTA DE PEDIATRIA 2016. [DOI: 10.1016/j.rpped.2015.06.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Versteegh HP, van den Hondel D, IJsselstijn H, Wijnen RMH, Sloots CEJ, de Blaauw I. Cloacal malformation patients report similar quality of life as female patients with less complex anorectal malformations. J Pediatr Surg 2016; 51:435-9. [PMID: 26382284 DOI: 10.1016/j.jpedsurg.2015.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/02/2015] [Accepted: 07/28/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Cloacal malformations are the most complex type of anorectal malformation in females. This study aimed to report quality of life (QoL) of patients with a cloacal malformation for the first time in literature. MATERIALS AND METHODS Female patients with an anorectal malformation participating in a follow-up program for congenital malformation survivors aged 5 or older were eligible for this study. QoL was assessed with the PedsQL™ 4.0 inventory. Scores of patients with a cloacal malformation (CM) were compared with those of female patients with rectoperineal or rectovestibular fistulas (RP/RV) and with reference data. RESULTS A total of 59 patients (67% response rate; 13 patients with cloacal malformation) were included, QoL was assessed by patient self-report at median age of 12years (8-13), and by parent proxy-report at median age of 8years (5-12). There were no differences between groups regarding the presence of associated anomalies, with also no differences regarding anomalies in the urinary tract (CM vs. RP/RV=31% vs. 15%, p=0.237). Scores of the cloacal malformations group were similar to those of the comparison group, except the proxy-reported scores on school functioning (60.0 vs. 80.0, p=0.003). Proxy-reported scores of cloacal malformation patients were significantly lower than reference values on total QoL-score, psychosocial health, and emotional and school performance. Patients (irrespective of type of ARM) who suffered from fecal soiling reported significantly lower scores with regard to psychosocial health (71.7 vs. 81.7, p=0.034) and its subscale school performance (65.0 vs. 80.0, p<0.001). QoL-scores reported by cloacal malformation patients did not differ significantly from the reference values of the healthy population. Parents of cloacal malformation patients reported significantly lower total QoL, emotional and school performances, as well as a lower general psychosocial health for their children relative to reference data of healthy children. CONCLUSION Patients with cloacal malformations and females with less complex anorectal malformations report similar QoL. Parents of cloacal malformation patients report more problems on several psychosocial domains relative to the healthy reference group. To monitor these matters, long-term follow-up protocols should contain multidisciplinary treatment including periodical assessment of psychosocial well-being.
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Affiliation(s)
- H P Versteegh
- Department of Pediatric Surgery, Sophia Children's Hospital-Erasmus Medical Center, Rotterdam, the Netherlands.
| | - D van den Hondel
- Department of Pediatric Surgery, Sophia Children's Hospital-Erasmus Medical Center, Rotterdam, the Netherlands
| | - H IJsselstijn
- Department of Pediatric Surgery, Sophia Children's Hospital-Erasmus Medical Center, Rotterdam, the Netherlands
| | - R M H Wijnen
- Department of Pediatric Surgery, Sophia Children's Hospital-Erasmus Medical Center, Rotterdam, the Netherlands
| | - C E J Sloots
- Department of Pediatric Surgery, Sophia Children's Hospital-Erasmus Medical Center, Rotterdam, the Netherlands
| | - I de Blaauw
- Department of Pediatric Surgery, Sophia Children's Hospital-Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatric Surgery, Amalia Children's Hospital-Radboud University Medical Center, Nijmegen, the Netherlands
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Mathias AL, Tannuri ACA, Ferreira MAE, Santos MM, Tannuri U. [Validation of questionnaires to assess quality of life related to fecal incontinence in children with anorectal malformations and Hirschsprung's disease]. ACTA ACUST UNITED AC 2015; 34:99-105. [PMID: 26522822 PMCID: PMC4795728 DOI: 10.1016/j.rppede.2015.06.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 06/11/2015] [Accepted: 06/16/2015] [Indexed: 11/19/2022]
Abstract
Objective: Surgical treatment of anorectal malformations (ARMs) and Hirschsprung's disease
(HD) leads to alterations in bowel habits and fecal incontinence, with consequent
quality of life impairment. The objectives were to create and validate a
Questionnaire for the Fecal Incontinence Index (FII) based on the Holschneider
score, as well as a Questionnaire for the Assessment of Quality of Life Related to
Fecal Incontinence in Children and Adolescents (QQVCFCA), based on the Fecal
Incontinence Quality of Life. Methods: The questionnaires were applied to 71 children submitted to surgical procedure, in
two stages. Validity was tested by comparing the QQVCFCA and a generic quality of
life questionnaire (SF-36), and between QQVCFCA and the FII. A group of 59 normal
children was used as control. Results: At two stages, 45.0% (32/71) and 42.8% (21/49) of the patients had fecal
incontinence. It was observed that the QQVCFCA showed a significant correlation
with the SF-36 and FII (Pearson's correlation 0.57), showing that the quality of
life is directly proportional to improvement in fecal incontinence. Quality of
life in patients with fecal incontinence is still globally impaired, when compared
with control subjects (p<0.05, Student's
t-test). There were also significant differences between the
results of children with ARMs and children with HD. Conclusions: QQVCFCA and FII are useful tools to assess the quality of life and fecal
incontinence in these groups of children. Children with ARMs submitted to surgical
procedure and HD have similar quality of life impairment.
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Affiliation(s)
- Arthur Loguetti Mathias
- Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP, Brasil
| | - Ana Cristina Aoun Tannuri
- Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP, Brasil
| | | | - Maria Mercês Santos
- Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP, Brasil
| | - Uenis Tannuri
- Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo, SP, Brasil.
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Ameh EA, Seyi-Olajide JO, Sholadoye TT. Neonatal surgical care: a review of the burden, progress and challenges in sub-Saharan Africa. Paediatr Int Child Health 2015; 35:243-51. [PMID: 25948318 DOI: 10.1179/2046905515y.0000000033] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The outcome of neonatal surgery has significantly improved over the decades in high-income countries. In sub-Saharan Africa (SSA), however, it has lagged behind. This is a review of the current state of neonatal surgery in SSA. The conditions requiring surgery in the newborn are largely congenital but the rate of emergency surgery is high, reaching 40% of all neonatal surgery in some settings. Most operations are for intestinal obstruction, commonly owing to anorectal malformations and intestinal atresia, as well as abdominal wall defects. Many of the patients are delivered outside a hospital facility and often present or are referred late and are very ill at time of presentation. The morbidity following surgery is high, particularly from surgical site infections and respiratory problems. Mortality is high, sometimes reaching 45%, but has decreased in recent times. Because of a lack of trained paediatric anaesthetists, anaesthesia is often problematic and surgery is sometimes undertaken using a local anaesthetic. Further care, including bowel management and orthopaedic and neurological rehabilitation, are sub-optimal owing to a lack of appropriately trained personnel and financial constraints. While the number of paediatric surgeons has increased, there are still few anaesthetists. In order to significantly improve the outcome for neonates with surgical problems in SSA, paediatric surgery, anaesthesia, neonatology and neonatal nursing capacity need to be scaled up and fast-tracked. To make neonatal surgery safer in these settings, neonatal intensive care facilities need to be provided and improved.
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Grano C, Bucci S, Aminoff D, Lucidi F, Violani C. Transition from childhood to adolescence: Quality of life changes 6 years later in patients born with anorectal malformations. Pediatr Surg Int 2015; 31:735-40. [PMID: 26143409 DOI: 10.1007/s00383-015-3736-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND/PURPOSE Disease-specific quality of life (QoL) may be more or less relevant when children enter preadolescence/adolescence. Few attentions have been given to development and transition periods. Aim of the present longitudinal study is to evaluate ARM specific changes in QoL and the stability of QoL over 6 years. METHODS Questionnaires were sent to families of the AIMAR Association (in 2007 and in 2013/2014). They included the Hirschsprung's Disease/ARM QoL Questionnaire (HAQL, [1]). Rank correlations and within group comparisons for the HAQL subscales were conducted analyzing the scores of time 1 vs time 2. Gender effects were tested. RESULTS 134 parents answered the questionnaires at time 1 and 73 at time 2. Results of the repeated Analyses of Variance indicated improvements in the continence subscales ("Presence of Diarrhea," "Fecal Continence"). QoL significantly worsened in "Social and Emotional Functioning" and in "Body Image" areas. The analysis of stability of change indicates that QoL scores remain stable, with the exception of the Body Image area. CONCLUSIONS Despite improvements in the continence areas, parents reported worse levels of QoL in the psychosocial areas, as their child grow. As patients grow, they might have more difficulties in daily and social activities, and feel more frequently ashamed and more dissatisfied with their body.
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Affiliation(s)
- Caterina Grano
- Department of Psychology, La Sapienza, University of Rome, Via dei Marsi, 78, 00185, Rome, Italy,
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Muise ED, Cowles RA. Transition of care in pediatric surgical patients with complex gastrointestinal disease. Semin Pediatr Surg 2015; 24:65-8. [PMID: 25770365 DOI: 10.1053/j.sempedsurg.2015.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Pediatric surgeons provide care for infants and children with a wide variety of conditions throughout the body. Many of these conditions are congenital or occur very early in life, and for this reason, providing continuity of care for these patients into adulthood is an emerging challenge. In the gastrointestinal tract, congenital and acquired conditions are now associated with excellent long-term prognosis; however, little guidance on long-term care exists. The aim of this article is to discuss aspects that are important to transitioning care of pediatric surgical patients with complex gastrointestinal disorders from pediatric to adult practitioners. Transitional care of patients with short bowel syndrome, Hirschsprung Disease, and anorectal malformations will be the focus of this discussion, but the concepts introduced here may translate to other diagnoses as well.
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Affiliation(s)
- Eleanor D Muise
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Robert A Cowles
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut.
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Kyrklund K, Pakarinen MP, Koivusalo A, Rintala RJ. Long-term bowel functional outcomes in rectourethral fistula treated with PSARP: controlled results after 4-29 years of follow-up: a single-institution, cross-sectional study. J Pediatr Surg 2014; 49:1635-42. [PMID: 25475809 DOI: 10.1016/j.jpedsurg.2014.04.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 03/24/2014] [Accepted: 04/27/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND/PURPOSE Posterior sagittal anorectoplasty (PSARP) has become the standard surgical treatment for males rectourethral fistula (RUF) at most surgical centers worldwide. We aimed to define the long-term bowel functional outcomes following PSARP for RUF at our institution between 1983 and 2006, with comparison to age- and gender-matched controls. METHODS Patients were invited to answer a detailed, previously validated Bowel Function Score (BFS) questionnaire by post. Respondents were matched by age and gender to three controls from the general population who had answered identical questionnaires. Case records were reviewed retrospectively for operative details. Ethical approval was obtained. Social continence was defined as soiling or fecal accidents <1/week and no requirement for changes of underwear or protective aids. RESULTS Of 34 (79%) respondents (median age 19 (range, 4-29) years), 74% had voluntary bowel movements (VBMs), 24% were reliant on anterograde continence enema (ACE) washouts, and 1 patient had a colostomy. Impairment of bowel function was significantly higher in all aspects of fecal control among patients than controls (p<0.001). A statistically significant decline in fecal accidents and soiling was observed with age (p ≤ 0.03). Thirty-one percent of patients with VBMs had constipation managed with diet or laxatives (vs 2% of controls, p=0.0002). Of patients with VBMs followed up for > 12 years (n=20), 50% were completely continent (vs 73% of controls; p=NS). Overall, 76% of respondents were socially continent with or without artificial means in the form of ACE washouts. By BFS score, 39% had a good functional outcome, 27% had a moderate outcome, 9% had a clearly poor score and 24% were living with an ACE. CONCLUSIONS Our results suggest that in the long-term, functional symptoms remain highly prevalent among patients treated for RUF with PSARP. However, the majority can be expected to achieve social continence, although for some this will require intervention with ACE bowel management. Approximately one third may report VBMs and complete continence.
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Affiliation(s)
- Kristiina Kyrklund
- Department of Pediatric Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland.
| | - Mikko P Pakarinen
- Department of Pediatric Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Antti Koivusalo
- Department of Pediatric Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
| | - Risto J Rintala
- Department of Pediatric Surgery, Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland
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Cretolle C, Rousseau V, Lottmann H, Irtan S, Lortat-Jacob S, Alova I, Michel JL, Aigrain Y, Podevin G, Lehur PA, Sarnacki S. [Anorectal malformations]. Arch Pediatr 2013; 20 Suppl 1:S19-27. [PMID: 23992833 DOI: 10.1016/s0929-693x(13)71405-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Anorectal malformations (ARM) are the result of an abnormal development of the terminal part of the digestive tract interesting anus and/or rectum that occur early between the sixth and tenth week of embryonic development. They carry a malformation spectrum of severity depending on the level of disruption of the anorectal canal and of the associated caudal malformations (sacrum and spine). ARM are associated in over half the cases with other malformations that can be integrated in some cases in known syndromes. If surgical treatment to restore anatomy as normal as possible is indispensable, post-operative care is essential for these patients whose defecation mechanisms are altered, to reach if not continence, at least a socially acceptable cleanliness.
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Affiliation(s)
- C Cretolle
- Service de Chirurgie pédiatrique, CRMR Malformations ano-rectales et pelviennes rares (MAREP), Hôpital Necker Enfants Malades, Université Paris Descartes, 149 rue de Sèvres, 75015 Paris, France
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Abstract
PURPOSE Quality of life (QOL) is an important endpoint in health outcomes research, especially in pediatric chronic conditions. While some studies suggest that patients with ARM report a lower level of physical and psychosocial QOL, as compared to healthy peers, not all research shows this consistently. The aim of this study was to compare the QOL of Italian children and adolescents with ARM to the QOL of a large control sample of healthy peers. METHODS Parents of 109 children with ARM and 336 schoolchildren, completed the Pediatric Quality of Life Inventory. Analysis of variances were used to compare the groups. RESULTS Compared to healthy peers, children with ARM showed lower emotional functioning (F = 8,41; p = .004), social functioning (F = 4,9; p = .027) and school functioning (F = 14,7; p = .000). In the adolescent group, females had a worse QOL in the physical functioning domain (F = 5,01; p = .03) than males, independent of group membership. CONCLUSIONS While children with ARM show a more impaired QOL compared to their peers, this difference does not emerge in the adolescent group. Our results are consistent with previous findings which hypothesize that while patients with ARM face more difficulties during childhood, by adolescence they may have learned to overcome these difficulties.
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Mantoo S, Meurette G, Wyart V, Hardouin J, Cretolle C, Capito C, Sarnacki S, Podevin G, Lehur PA. The impact of anorectal malformations on anorectal function and social integration in adulthood: report from a national database. Colorectal Dis 2013; 15:e330-5. [PMID: 23464709 DOI: 10.1111/codi.12186] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 12/15/2012] [Indexed: 12/21/2022]
Abstract
AIM The impact of anorectal malformation (ARM) on bowel function and social, educational and occupational end-points was investigated in adult patients entered on a national database. METHOD Data from a national database of adult patients operated on between 1962 and 1999 for ARM were analysed. The database Malformations Ano-rectales et Pelviennes rares (MAREP) was part of a common information system, CEMARA, on rare congenital disorders. A self-administered questionnaire regarding bowel function, academic qualifications, employment and family status was mailed to patients. The type of ARM, subsequent follow-up and management including surgical interventions were retrospectively retrieved from medical records. RESULTS Of 210 adult patients on the registry since 2008, 68 were included in this study. Only three (8.5%) had had regular follow-up. All reported some disturbance in bowel function. The fertility rate of 1.5 children per woman did not differ from the general population. CONCLUSION Anorectal malformation ARM often leads to suboptimal bowel function in adulthood. This has an impact on social integration.
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Affiliation(s)
- S Mantoo
- Department of Surgery, Khoo Teck Puat Hospital, Singapore City, Singapore
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