1
|
Saenz ZM, Austin K, Avansino JR, Badillo A, Calkins CM, Durham MM, Fuller MK, Rana A, Reeder RW, Rentea RM, Rollins MD, Speck KE, Wood RJ, Harris JC, Anderson J, Hassan M, Saadai P. Can Anorectal Stenosis be Managed With Dilations Alone? A PCPLC Review. J Pediatr Surg 2024; 59:1652-1656. [PMID: 38735806 DOI: 10.1016/j.jpedsurg.2024.04.007] [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] [Received: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE Congenital anorectal stenosis is managed by dilations or operative repair. Recent studies now propose use of dilations as the primary treatment modality to potentially defer or eliminate the need for surgical repair. We aim to characterize the management and outcomes of these patients via a multi-institutional review using the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) registry. METHODS A retrospective database review was performed using the PCPLC registry. The patients were evaluated for demographics, co-morbidities, diagnostic work-up, surgical intervention, current bowel management, and complications. RESULTS 64 patients with anal or rectal stenosis were identified (57 anal, 7 rectal) from a total of 14 hospital centers. 59.6% (anal) and 42.9% (rectal) were male. The median age was 3.2 (anal) and 1.9 years (rectal). 11 patients with anal stenosis also had Currarino Syndrome with 10 of the 11 patients diagnosed with a presacral mass compared to only one rectal stenosis with Currarino Syndrome and a presacral mass. 13 patients (22.8%, anal) and one (14.3%, rectal) underwent surgical correction. Nine patients (8 anal, 1 rectal) underwent PSARP. Other procedures performed were cutback anoplasty and anterior anorectoplasty. The median age at repair was 8.4 months (anal) and 10 days old (rectal). One patient had a wound complication in the anal stenosis group. Bowel management at last visit showed little differences between groups or treatment approach. CONCLUSION The PCPLC registry demonstrated that these patients can often be managed successfully with dilations alone. PSARP is the most common surgical repair chosen for those who undergo surgical repair. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Zoe M Saenz
- Department of Surgery, UC Davis Children's Hospital, University of California Davis, Sacramento, CA, USA; Department of Surgery, Shriners Hospital for Children-Northern California, Sacramento, CA, USA
| | - Kelly Austin
- Department of Surgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeffrey R Avansino
- Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Andrea Badillo
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, George Washington University, Washington, DC, USA
| | - Casey M Calkins
- Department of Surgery, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Megan M Durham
- Department of Surgery, Emory + Childrens Pediatric Institute Atlanta, GA, USA
| | - Megan K Fuller
- Department of Surgery, Boys Town National Research Hospital, University of Nebraska Medical Center, Boys Town, NE, USA
| | - Ankur Rana
- Department of Surgery and Perioperative Care, Dell Children's Medical Center, University of Texas Austin, Austin, TX, USA
| | - Ron W Reeder
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Rebecca M Rentea
- Department of Surgery, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Michael D Rollins
- Department of Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | - K Elizabeth Speck
- Division of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Richard J Wood
- Department of Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Jamie C Harris
- Department of Surgery, Phoenix Children's Hospital, University of Arizona, Phoenix, AZ, USA
| | - Jamie Anderson
- Department of Surgery, UC Davis Children's Hospital, University of California Davis, Sacramento, CA, USA; Department of Surgery, Shriners Hospital for Children-Northern California, Sacramento, CA, USA
| | - Maheen Hassan
- Department of Surgery, UC Davis Children's Hospital, University of California Davis, Sacramento, CA, USA; Department of Surgery, Shriners Hospital for Children-Northern California, Sacramento, CA, USA
| | - Payam Saadai
- Department of Surgery, UC Davis Children's Hospital, University of California Davis, Sacramento, CA, USA; Department of Surgery, Shriners Hospital for Children-Northern California, Sacramento, CA, USA.
| |
Collapse
|
2
|
Wang C, Li M, Li S, Wei X, Dong N, Liu S, Yuan Z, Li B, Pierro A, Tang X, Bai Y. Rack1-mediated ferroptosis affects hindgut development in rats with anorectal malformations: Spatial transcriptome insights. Cell Prolif 2024; 57:e13618. [PMID: 38523594 PMCID: PMC11216944 DOI: 10.1111/cpr.13618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/04/2024] [Accepted: 02/07/2024] [Indexed: 03/26/2024] Open
Abstract
Anorectal malformation (ARM), a common congenital anomaly of the digestive tract, is a result of insufficient elongation of the urorectal septum. The cytoplasmic protein Receptor of Activated C-Kinase 1 (Rack1) is involved in embryonic neural development; however, its role in embryonic digestive tract development and ARM formation is unexplored. Our study explored the hindgut development and cell death mechanisms in ARM-affected rats using spatial transcriptome analysis. We induced ARM in rats by administering ethylenethiourea via gavage on gestational day (GD) 10. On GDs 14-16, embryos from both normal and ARM groups underwent spatial transcriptome sequencing, which identified key genes and signalling pathways. Rack1 exhibited significant interactions among differentially expressed genes on GDs 15 and 16. Reduced Rack1 expression in the ARM-affected hindgut, verified by Rack1 silencing in intestinal epithelial cells, led to increased P38 phosphorylation and activation of the MAPK signalling pathway. The suppression of this pathway downregulated Nqo1 and Gpx4 expression, resulting in elevated intracellular levels of ferrous ions, reactive oxygen species (ROS) and lipid peroxides. Downregulation of Gpx4 expression in the ARM hindgut, coupled with Rack1 co-localisation and consistent mitochondrial morphology, indicated ferroptosis. In summary, Rack1, acting as a hub gene, modulates ferrous ions, lipid peroxides, and ROS via the P38-MAPK/Nqo1/Gpx4 axis. This modulation induces ferroptosis in intestinal epithelial cells, potentially influencing hindgut development during ARM onset.
Collapse
Affiliation(s)
- Chen‐Yi Wang
- Department of Pediatric SurgeryShengjing Hospital of China Medical UniversityShenyangChina
| | - Mu‐Yu Li
- Department of Pediatric SurgeryShengjing Hospital of China Medical UniversityShenyangChina
| | - Si‐Ying Li
- Department of Pediatric SurgeryShengjing Hospital of China Medical UniversityShenyangChina
| | - Xiao‐Gao Wei
- Department of Pediatric SurgeryShengjing Hospital of China Medical UniversityShenyangChina
| | - Nai‐Xuan Dong
- Department of Pediatric SurgeryShengjing Hospital of China Medical UniversityShenyangChina
| | - Shu‐Ting Liu
- Department of Pediatric SurgeryShengjing Hospital of China Medical UniversityShenyangChina
| | - Zheng‐Wei Yuan
- Key Laboratory of Health Ministry for Congenital MalformationShengjing Hospital of China Medical UniversityShenyangChina
| | - Bo Li
- Division of General and Thoracic SurgeryThe Hospital for Sick ChildrenTorontoCanada
| | - Agostino Pierro
- Division of General and Thoracic SurgeryThe Hospital for Sick ChildrenTorontoCanada
| | - Xiao‐Bing Tang
- Department of Pediatric SurgeryShengjing Hospital of China Medical UniversityShenyangChina
| | - Yu‐Zuo Bai
- Department of Pediatric SurgeryShengjing Hospital of China Medical UniversityShenyangChina
| |
Collapse
|
3
|
Ambartsumyan L. Medical management of anorectal malformations. Aliment Pharmacol Ther 2024; 60 Suppl 1:S77-S84. [PMID: 38924569 DOI: 10.1111/apt.17897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 11/28/2023] [Accepted: 01/26/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Anorectal malformations (ARMs) are congenital anomalies of the anorectum and the genitourinary system that result in a broad spectrum of hindgut anomalies. Despite surgical correction patients continue to have late postoperative genitourinary and colorectal dysfunction that have significant impact on quality of life. AIM This paper will review the current evidence and discuss the evaluation and management of postoperative patients with ARMs who present with persistent defecation disorder. METHODS A literature search was conducted using PubMed/MEDLINE/EMBASE databases applying the following terms: ARMs, imperforate anus, constipation, faecal incontinence, neurogenic bowel, posterior sagittal anorectoplasty. RESULTS Patients who present with postoperative defecation disorders require timely diagnostic and surgical evaluation for anatomic abnormalities prior to initiation of bowel management. Goals of management are to avoid constipation in young children, achieve faecal continence in early childhood and facilitate independence in older children and adolescents. Treatment options vary from high dose stimulant laxatives to high-volume retrograde and antegrade enemas that facilitate mechanical colonic emptying. CONCLUSIONS Appropriate diagnostic work-up and implementation of treatment can decrease long-term morbidity and improve quality of life in postoperative patients with ARMs who presents with defecation disorders.
Collapse
Affiliation(s)
- Lusine Ambartsumyan
- Division of Gastroenterology and Nutrition, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, Washington, USA
| |
Collapse
|
4
|
Chi Y, Yao Y, Sun F, Zhang W, Zhang Z, Wang Y, Hao W. A novel SALL1 C757T mutation in a Chinese family causes a rare disease --Townes-Brocks syndrome. Ital J Pediatr 2024; 50:121. [PMID: 38915054 PMCID: PMC11197267 DOI: 10.1186/s13052-024-01691-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 06/09/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND Townes-Brocks syndrome (TBS) is a rare genetic disorder characterized by imperforate anus, dysplastic ears, thumb malformations, and other abnormalities. Previous studies have revealed that mutations in the SALL1 gene can disrupt normal development, resulting in the characteristic features of Townes-Brocks syndrome. Spalt-like transcription factors (SALLs) are highly conserved proteins that play important roles in various cellular processes, including embryonic development, cell differentiation, and cell survival. Over 400 different variants or mutations have been reported in the SALL1 gene in individuals with TBS. Most of these variants lead to the formation of premature termination codons (PTCs), also known as nonsense mutations. The majority of these PTCs occur in a specific region of the SALL1 gene called the "hotspot region", which is particularly susceptible to mutation. METHODS In this study, we conducted whole-exome sequencing on a three-generation Chinese family with anorectal malformations. RESULTS We identified a novel heterozygous mutation (chr16:51175376:c.757 C > T p.Gln253*) in the SALL1 gene. Molecular analysis revealed a heterozygous C to T transition at nucleotide position 757 in exon 2 of the SALL1 (NM_002968) gene. This mutation is predicted to result in the substitution of the Gln253 codon with a premature stop codon (p.Gln253*). The glutamine-rich domain forms a long alpha helix, enabling the mutant protein to interact with the wild-type SALL1 protein. This interaction may result in steric hindrance effects on the wild-type SALL1 protein. CONCLUSIONS Our findings have expanded the mutation database of the SALL1 gene, which is significant for genetic counseling and clinical surveillance in the affected family. Furthermore, our study enhances the understanding of Townes-Brocks syndrome and has the potential to improve its diagnosis and treatment.
Collapse
Affiliation(s)
- Yunqian Chi
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong Province, PR China
| | - Yi Yao
- Basic Medical College, Guangxi Medical University, Nanning, 530021, Guangxi Province, PR China
| | - Futao Sun
- Department of Pediatric Surgery, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong Province, PR China
| | - Wenhong Zhang
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong Province, PR China
| | - Zihan Zhang
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong Province, PR China
| | - Yunhe Wang
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong Province, PR China
| | - Wei Hao
- Department of Neonatology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, Shandong Province, PR China.
- Shandong Provincial Hospital, Shandong First Medical University, Jinan, 250021, Shandong Province, China.
| |
Collapse
|
5
|
Hu H, Huang Y, Ke S, Xu Y, Jing X. A child With Diphallia, Duplicate Bladder, Bladder Exstrophy, and Anorectal Malformation. Urology 2024:S0090-4295(24)00478-3. [PMID: 38914230 DOI: 10.1016/j.urology.2024.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 06/13/2024] [Indexed: 06/26/2024]
Abstract
Congenital true diphallia, complete duplicate bladder, bladder exstrophy, and anorectal malformation in a child are uncommon. Here, we present the case of a 3-year-old boy with multiple genitourinary malformation, including true diphallia, complete duplicate bladder, bladder exstrophy, epispadias, and anorectal malformation. Multi-departmental collaborative treatment for complex conditions ultimately achieved an ideal appearance for this patient. All vital signs were stable after the surgery and they remained consistent during follow-up. In such cases, surgical correction is individualized to achieve adequate urinary continence and erection with adequate esthetics.
Collapse
Affiliation(s)
- Huiyong Hu
- Department of the Ultrasonography, Shanghai Children's Hospital, Shanghai Jiao Tong University, school of medicine, Shanghai, China
| | - Yichen Huang
- Department of Urology, Shanghai Children's Hospital, Shanghai Jiao Tong University, school of medicine, Shanghai, China
| | - Shujun Ke
- Department of Radiology, Shanghai Children's Hospital, Shanghai Jiao Tong University, school of medicine, Shanghai, China
| | - Yunfeng Xu
- Department of the Ultrasonography, Shanghai Children's Hospital, Shanghai Jiao Tong University, school of medicine, Shanghai, China
| | - Xiaoping Jing
- Department of Traditional Chinese Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, school of medicine, Shanghai, China.
| |
Collapse
|
6
|
Suluhan D, Haji Mohamud RY. "The People Criticized Me and Insulted Me Due to Having a Child with Defect": Experiences of Somali Parents of Children with Anorectal Malformation. J Multidiscip Healthc 2024; 17:2789-2798. [PMID: 38863765 PMCID: PMC11166148 DOI: 10.2147/jmdh.s462391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 05/27/2024] [Indexed: 06/13/2024] Open
Abstract
Background Treatment of anorectal malformations (ARM) and the management of clinical outcomes are challenging for families. While most studies focus on mothers suffering from care burden, high stress, and low quality of life, there is limited knowledge of what fathers of children with ARM experience; therefore, this study aimed to examine how both mothers and fathers have experience caring for children with ARM and how beliefs and cultural issues affect the perception of congenital anomalies. Methods A qualitative design. Consolidated criteria for reporting the qualitative research guidelines were used in this study. The guidelines for thematic analysis were followed for data analysis. Results Ten mothers and six fathers were interviewed, and their mean age was 32.5 ± 4.2 years. Of the 75% (n = 12) illiterate and 93.7% (n = 15) had an expanded family type, all their religious affiliations were Muslim. The four main themes were (1) ambiguity, (2) challenges, (3) stigma, and (4) coping, which were determined in line with the results of the data analysis of parents' views on having and caring for children with ARM. Conclusion In this study, many Somali parents reported that they lacked disease and treatment knowledge, physical exhaustion, and some difficulties related to a lack of access to the hospital because of living in rural areas, caring for the child, and dealing with long-term complications, colostomy, anal dilatation, and enema before or after anoplasty. While all parents mentioned that having a child with ARM was a fate, it was seen as punishment by their close social environment. Consequently, this study could serve as a foundation for planning comprehensive healthcare and physical and psychosocial support for multidisciplinary health professionals.
Collapse
Affiliation(s)
- Derya Suluhan
- Department of Pediatric Nursing, Gulhane Faculty of Nursing,University of Health Sciences Türkiye, Ankara, Türkiye
| | - Rahma Yusuf Haji Mohamud
- Department of Education, Mogadishu Somalia-Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia
| |
Collapse
|
7
|
Alharbi R, Suchet-Dechaud A, Harzallah I, Touraine R, Ramond F. Expanding the clinical spectrum of Coffin-Siris syndrome with anorectal malformations: Case report and review of the literature. Eur J Med Genet 2024; 69:104948. [PMID: 38735569 DOI: 10.1016/j.ejmg.2024.104948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 05/06/2024] [Accepted: 05/09/2024] [Indexed: 05/14/2024]
Abstract
Anorectal malformations (ARMs) represent a wide spectrum of congenital anomalies of the anus and rectum, of which more than half are syndromic. Their etiology is highly heterogeneous and still poorly understood. We report a 4-year-old girl who initially presented with an isolated ARM, and subsequently developed a global developmental delay as part of an ARID1B-related Coffin-Siris syndrome (CSS). A co-occurrence of ARMs and CSS in an individual by chance is unexpected since both diseases are very rare. A review of the literature enabled us to identify 10 other individuals with both CSS and ARMs. Among the ten individuals reported in this study, 8 had a variant in ARID1A, 2 in ARID1B, and 1 in SMARCA4. This more frequent than expected association between CSS and ARM indicates that some ARMs are most likely part of the CSS spectrum, especially for ARID1A-related CSS.
Collapse
Affiliation(s)
- Ralah Alharbi
- Service de Génétique, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne, France; Department of Genetics, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Anna Suchet-Dechaud
- Service de Génétique, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne, France
| | - Inès Harzallah
- Service de Génétique, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne, France
| | - Renaud Touraine
- Service de Génétique, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne, France
| | - Francis Ramond
- Service de Génétique, Hôpital Nord, CHU Saint-Etienne, Saint-Etienne, France.
| |
Collapse
|
8
|
Wang K, Peng C, Pang W, Wang Z, Wu D, Chen Y. Long-term (> 10 years) bowel function of anorectal malformations: a retrospective single-center study. Pediatr Surg Int 2024; 40:138. [PMID: 38796646 DOI: 10.1007/s00383-024-05731-y] [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: 05/23/2024] [Indexed: 05/28/2024]
Abstract
PURPOSE To describe the long-term bowel function of anorectal malformation (ARM) patients and explore the potential influence factors. METHODS ARM patients with follow-up data > 10 years were included. Cases of cloaca, Currarino syndrome, and VACTERL syndrome were excluded. Rintala score and PedsQL 4.0 were used to assess bowel function score (BFS) and quality of life (QoL). Based on the results, patients were divided into satisfactory group with BFS ≥ 17 and unsatisfactory group with it < 17. Comparisons between the groups were made. RESULTS Among the 81 patients were 44 males and 37 females. Follow-up time was 138 (126,151) months. 16 (19.75%) patients had associated anomalies. 23 (28.40%) patients had reoperations, and fistula recurrence was the most common reason. BFS of the patients was 20 (18,20). QoL score was 100 (100,100), which correlated positively with BFS (r = 0.648, P < 0.001). The satisfactory and the unsatisfactory groups had 69 and 12 cases, and their BFS were 20 (20,20) and 11 (8,15) respectively, which had statistical difference (P < 0.001). Total QoL score and psycho-social health score of the unsatisfactory group were lower (P < 0.001). Only reoperations were statistically different between the groups (P < 0.001). CONCLUSIONS Long-term (> 10 years) bowel function of ARM patients is good in this study. Defecation problems have negative impacts on QoL and mainly affects their psycho-social health. Primary anorectoplasty is extremely important. Reoperations, which are most commonly seen in recto-urethral fistula recurrence, adversely affect the outcome.
Collapse
Affiliation(s)
- Kai Wang
- Department of General Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, No.56 Nanlishi st, Xicheng District, Beijing, 100045, China
| | - Chunhui Peng
- Department of General Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, No.56 Nanlishi st, Xicheng District, Beijing, 100045, China
| | - Wenbo Pang
- Department of General Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, No.56 Nanlishi st, Xicheng District, Beijing, 100045, China
| | - Zengmeng Wang
- Department of General Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, No.56 Nanlishi st, Xicheng District, Beijing, 100045, China
| | - Dongyang Wu
- Department of General Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, No.56 Nanlishi st, Xicheng District, Beijing, 100045, China
| | - Yajun Chen
- Department of General Surgery, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, No.56 Nanlishi st, Xicheng District, Beijing, 100045, China.
| |
Collapse
|
9
|
Sun Y, Liang H, Hao S, Yin L, Pan Y, Wang C, Lu J. A case-control study of the risk factors for fistula-in-ano in infants and toddlers. BMC Pediatr 2024; 24:362. [PMID: 38783262 PMCID: PMC11118725 DOI: 10.1186/s12887-024-04826-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Limited data are available regarding the risk factors for fistula-in-ano (FIA) in infants and toddlers, potentially affecting their daily lives. OBJECTIVES The purpose of this study was to identify potential risk factors for FIA in infants and toddlers, in order to implement early preventive interventions, avoid disease progression, and develop therapeutic strategies. DESIGN AND SETTINGS A retrospective case-control study was conducted, comparing 41 infants and toddlers diagnosed with FIA with 41 healthy controls, between August 2020 and December 2021. INDEPENDENT VARIABLES (a) maternal characteristics during pregnancy and delivery, (b) perinatal characteristics, dietary behaviors, and defecation-related behaviors in infants and toddlers, (c) family dietary behaviors. RESULTS Mothers of infants and toddlers with FIA had given birth more times in the past, while the infants and toddlers themselves had less mealtime, a higher rate of exclusive breastfeeding, frequent loose stools, and a larger proportion of used wipes, experiencing perianal skin anomalies. The logistic regression analysis revealed that there are four significant risk factors associated with the development of FIA in infants and toddlers, including the number of previous deliveries by the mother (OR 6.327), defecation frequency score (OR 5.351), stool consistency score (OR 5.017), and cleaning with wipes after defecation (OR 8.089). CONCLUSION Based on our data, it appeared that FIA in infants and toddlers could be attributed to several factors. These included an increased number of previous deliveries by mothers, frequent loose stools, and repeated wipe use. To prevent the occurrence and worsening of the disease, it is important to improve the frequency and consistency of stooling and provide proper care. Further research is required to verify these findings in other clinical settings.
Collapse
Affiliation(s)
- Yanting Sun
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Chinese Traditional Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hongtao Liang
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Shuang Hao
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lu Yin
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Chinese Traditional Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yibin Pan
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chen Wang
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- Institute of Chinese Traditional Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jingen Lu
- Department of Anorectal Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
- Institute of Chinese Traditional Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| |
Collapse
|
10
|
Srinivas S, Scheiber AJ, Ahmad H, Thomas J, Weaver L, Wood RJ, Hewitt G, McCracken K. Examining Results of Post-Thelarche Screening Pelvic Ultrasound in Females with Anorectal Malformations. J Pediatr Adolesc Gynecol 2024:S1083-3188(24)00228-6. [PMID: 38768703 DOI: 10.1016/j.jpag.2024.05.001] [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: 01/12/2024] [Revised: 05/08/2024] [Accepted: 05/15/2024] [Indexed: 05/22/2024]
Abstract
STUDY OBJECTIVE Mullerian duct anomalies are common in females with anorectal malformations (ARMs), although there are no universally recommended screening protocols for identification. Historically, at our institution, we have recommended a screening pelvic ultrasound (PUS) 6 months after thelarche and menarche. We aimed to evaluate outcomes associated with our post-thelarche screening PUS in females with ARMs. METHODS An institutional review board-approved retrospective chart review was performed for all female patients 8 years old or older with ARMs and documented thelarche. Data were collected on demographic characteristics and clinical course. The primary outcome was adherence to the recommended PUS. Secondary outcomes included imaging correlation with suspected Mullerian anatomy and need for intervention on the basis of imaging findings. RESULTS A total of 112 patients met the inclusion criteria. Of them, 87 (77.7%) completed a recommended post-thelarche screening PUS. There were no differences in completion on the basis of age, race, establishment with a primary care provider, insurance status, or type of ARM. Nine patients (10.3%) had findings on their PUS that did not correlate with their suspected Mullerian anatomy; five (5.7%) required intervention, with two requiring menstrual suppression, two requiring surgical intervention, and one requiring further imaging. CONCLUSION Most patients completed the recommended post-thelarche screening PUS. In a small subset of patients, PUS did not correlate with suspected Mullerian anatomy and generated a need for intervention. Post-thelarche PUS can be a useful adjunct in patients with ARMs to identify gynecologic abnormalities.
Collapse
Affiliation(s)
- Shruthi Srinivas
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio.
| | | | - Hira Ahmad
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio
| | - Jessica Thomas
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio
| | - Laura Weaver
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio
| | - Richard J Wood
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio
| | - Geri Hewitt
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, Ohio
| | - Kate McCracken
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio; Department of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, Ohio
| |
Collapse
|
11
|
Li S, Ye S, Zhou Y, Diao M, Li L. Laparoscopic-assisted distal colon excision and proximal colon pull-through anorectoplasty for anorectal malformation. Front Pediatr 2024; 12:1402666. [PMID: 38798309 PMCID: PMC11116797 DOI: 10.3389/fped.2024.1402666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/30/2024] [Indexed: 05/29/2024] Open
Abstract
Purpose During the second stage surgery for anorectal malformations (ARM), patients whose distal intestine of the colostomy is particularly short underwent laparoscopic-assisted distal colon excision and proximal colon pull-through anorectoplasty (PCPARP). This study aimed to discuss the outcomes of PCPARP after colostomy in patients with ARM. Methods This is a single-center propensity score-matched (PSM) study which was retrospectively initiated patients with intermediate- or high-type ARM who underwent laparoscopic surgery from June 2007 to December 2018. These patients were divided into PCPARP group and conventional laparoscopic-assisted anorectoplasty (LAARP) group according to specific surgical methods. The general data, surgical data, postoperative complications, and functional results were evaluated. Results In total, 216 patients were included in this study: 190 (88.0%) undergoing LAARP approach and 26 (12.0%) undergoing PCPARP approach. After PSM, two well-balanced groups of 26 patients were analyzed and showed the postoperative complications (P = 0.126) and bowel function (P = 0.809) were similiar between the two groups. Conclusions The curative effect of PCPARP after colostomy is similar to that of classic LAARP surgery, which can be used for ARM patients with a very short and abnormal distal intestine of the stoma.
Collapse
Affiliation(s)
- Siqi Li
- Department of Pediatric Surgery, Children’s Hospital Capital Institute of Pediatrics, Chinese Academy of Medical Sciences & Peking Union Medical College, Research Unit of Minimally Invasive Pediatric Surgery on Diagnosis and Treatment, Chinese Academy of Medical Sciences 2021RU015, Beijing, China
| | - Shiru Ye
- Department of Pediatric Surgery, Children’s Hospital Capital Institute of Pediatrics, Chinese Academy of Medical Sciences & Peking Union Medical College, Research Unit of Minimally Invasive Pediatric Surgery on Diagnosis and Treatment, Chinese Academy of Medical Sciences 2021RU015, Beijing, China
| | - Yan Zhou
- Department of Pediatric Surgery, Children’s Hospital Capital Institute of Pediatrics, Chinese Academy of Medical Sciences & Peking Union Medical College, Research Unit of Minimally Invasive Pediatric Surgery on Diagnosis and Treatment, Chinese Academy of Medical Sciences 2021RU015, Beijing, China
| | - Mei Diao
- Department of Pediatric Surgery, Children’s Hospital Capital Institute of Pediatrics, Chinese Academy of Medical Sciences & Peking Union Medical College, Research Unit of Minimally Invasive Pediatric Surgery on Diagnosis and Treatment, Chinese Academy of Medical Sciences 2021RU015, Beijing, China
| | - Long Li
- Department of Pediatric Surgery, Children’s Hospital Capital Institute of Pediatrics, Chinese Academy of Medical Sciences & Peking Union Medical College, Research Unit of Minimally Invasive Pediatric Surgery on Diagnosis and Treatment, Chinese Academy of Medical Sciences 2021RU015, Beijing, China
- Department of Pediatric Surgery, Tsinghua University Affiliated Beijing Tsinghua Changgung Hospital, Beijing, China
| |
Collapse
|
12
|
Zhang Q, Xu J, Huang Q, Gong T, Li J, Cui Y. Risk factors for delayed extubation after pediatric perineal anaplasty in patients less than 1 year of age: a retrospective study. BMC Pediatr 2024; 24:307. [PMID: 38711038 DOI: 10.1186/s12887-024-04781-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 04/22/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Anorectal malformation is a common congenital problem occurring in 1 in 5,000 births and has a spectrum of anatomical presentations, requiring individualized surgical treatments for normal growth. Delayed extubation or reintubation may result in a longer intensive care unit (ICU) stay and hospital stay, increased mortality, prolonged duration of mechanical ventilation, increased tracheostomy rate, and higher hospital costs. Extensive studies have focused on the role of risk factors in early extubation during major infant surgery such as Cardiac surgery, neurosurgery, and liver surgery. However, no study has mentioned the influencing factors of delayed extubation in neonates and infants undergoing angioplasty surgery. MATERIALS AND METHODS We performed a retrospective study of neonates and infants who underwent anorectal malformation surgery between June 2018 and June 2022. The principal goal of this study was to observe the incidence of delayed extubation in pediatric anorectal malformation surgery. The secondary goals were to identify the factors associated with delayed extubation in these infants. RESULTS We collected data describing 123 patients who had anorectal malformations from 2019 to 2022. It shows that 74(60.2%) in the normal intubation group and 49(39.8%) in the longer extubation. In the final model, anesthesia methods were independently associated with delayed extubation (P < 0.05). CONCLUSION We found that the anesthesia method was independently associated with early extubation in neonates and infants who accepted pediatric anorectal malformation surgery.
Collapse
Affiliation(s)
- Qianqian Zhang
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's & Children's Central Hospital, Chengdu, 610091, China
| | - Jing Xu
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's & Children's Central Hospital, Chengdu, 610091, China
| | - Qinghua Huang
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's & Children's Central Hospital, Chengdu, 610091, China
| | - Tianqing Gong
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's & Children's Central Hospital, Chengdu, 610091, China
| | - Jia Li
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's & Children's Central Hospital, Chengdu, 610091, China
| | - Yu Cui
- Department of Anesthesiology, The Affiliated Hospital, School of Medicine, UESTC Chengdu Women's & Children's Central Hospital, Chengdu, 610091, China.
| |
Collapse
|
13
|
Glutig K, Veldhoen S. [Developmental disorders of the gastrointestinal tract]. RADIOLOGIE (HEIDELBERG, GERMANY) 2024; 64:392-399. [PMID: 38598006 DOI: 10.1007/s00117-024-01302-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Developmental disorders of the gastrointestinal tract comprise a broad spectrum of congenital malformations of different etiologies and locations from the mouth to the anus. METHODS The authors present the most important malformations of the gastrointestinal tract on the basis of basic and current reviews. RESULTS Gastrointestinal developmental disorders occur both sporadically and in connection with malformation syndromes. Symptoms are highly variable and range from postnatal emergencies to asymptomatic abnormalities, which may be incidental radiological findings. Prenatal ultrasound examinations can often identify gastrointestinal developmental disorders at an early stage. Here, fetal magnetic resonance imaging can be a useful addition to the diagnostic process. In the first few days of life, simple X‑ray overview images, supplemented by images after the administration of contrast medium, are often sufficient. CONCLUSION Many patients with a malformation of the gastrointestinal tract require lifelong medical care, so that not only pediatric radiologists need specific knowledge about this group of diseases.
Collapse
Affiliation(s)
- K Glutig
- Pädiatrische Radiologie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - S Veldhoen
- Pädiatrische Radiologie, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| |
Collapse
|
14
|
Huang G, Li W, Ma L, Lei X, Lin X, Chen Y, Xu B. Clinical application of middle descending colon-double lumen ostomy with distal stoma narrowing in the treatment of anorectal malformation. BMC Pediatr 2024; 24:207. [PMID: 38521911 PMCID: PMC10960438 DOI: 10.1186/s12887-024-04695-1] [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] [Received: 10/15/2023] [Accepted: 03/07/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Anorectal malformations (ARMs) are the most common congenital anomaly of the digestive tract. And colostomy should be performed as the first-stage procedure in neonates diagnosed with intermediate- or high-type ARMs. However, the most classic Pe˜na's colostomy still has some disadvantages such as complicated operation procedure, susceptibility to infection, a greater possibility of postoperative incision dehiscence, difficulty of nursing and large surgical trauma and incision scarring when closing the stoma. We aimed to explore the effectiveness of middle descending colon-double lumen ostomy (MDCDLO) in the treatment of high and intermediate types of anorectal malformations. METHODS We retrospectively reviewed the data of patients who underwent MDCDLO for high or intermediate types of ARMs between June 2016 and December 2021 in our hospital. The basic characteristics were recorded. All patients were followed up monthly to determine if any complication happen. RESULTS There were 17 boys and 6 girls diagnosed with high or intermediate types of ARMs in our hospital between June 2016 and December 2021. All 23 patients were cured without complications such as abdominal incision infection, stoma stenosis, incisional hernia, and urinary tract infection in the postoperative follow-up time of 6 months to 6 years except one case of proximal intestinal prolapse was restored under anesthesia. CONCLUSION MDCDLO offers the advantages of simplicity, efficiency, safety, mild trauma, and small scarring in the treatment of high and intermediate types of anorectal malformations.
Collapse
Affiliation(s)
- Guoxian Huang
- Department of Pediatric Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, 361000, Fujian, China.
| | - Wenni Li
- Department of Pediatric Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, 361000, Fujian, China
| | - Lili Ma
- Department of Pediatric Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, 361000, Fujian, China
| | - Xin Lei
- Department of Pediatric Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, 361000, Fujian, China
| | - Xiangde Lin
- Department of Pediatric Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, 361000, Fujian, China
| | - Yuandong Chen
- Department of Pediatric Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, 361000, Fujian, China
| | - Bo Xu
- Department of Pediatric Surgery, Women and Children's Hospital, School of Medicine, Xiamen University, Xiamen, 361000, Fujian, China
| |
Collapse
|
15
|
Lazarte-Rantes C, Chirinos-Gambarini M, Sulca-Cruzado GJ, Ramirez-De la Cruz R, Trigoso V, Cerron-Vela C, De la Torre-Mondragon L. T2-based magnetic resonance genitography in children with complex anorectal malformations: experience at a tertiary pediatric hospital in Latin America. Pediatr Radiol 2024; 54:430-437. [PMID: 38273134 DOI: 10.1007/s00247-023-05849-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 12/22/2023] [Accepted: 12/27/2023] [Indexed: 01/27/2024]
Abstract
In children with anorectal malformations (ARMs), it is essential to have a diagnostic imaging method that helps with the evaluation of the internal anatomy. In patients with a persistent cloaca, an ARM variant, in which the measurement of the urethral channel and common channel determines surgical management, there are multiple options for imaging. Magnetic resonance imaging (MRI) is an excellent method for this purpose, from which accurate measurements of channel length can be obtained. Additionally, the use of volumetric/isotropic sequences allows multiplanar reformatting. We present our experience with pelvic MRI and intracavitary non-paramagnetic contrast (MR genitography). This method uses volumetric T2-weighted images and the instillation of saline solution as a contrast agent to distinguish the common channel, length of the urethra, anatomy of the vagina, and presence and location of the rectal fistula. We believe this technique to be particularly useful for those working in settings with limited MRI resources.
Collapse
Affiliation(s)
- Claudia Lazarte-Rantes
- Department of Diagnostic Imaging, Instituto Nacional de Salud del Niño San Borja, Av. Javier Prado Este 3101, 15037, Lima, Peru.
| | - Mario Chirinos-Gambarini
- Department of Diagnostic Imaging, Instituto Nacional de Salud del Niño San Borja, Av. Javier Prado Este 3101, 15037, Lima, Peru
| | | | - Raul Ramirez-De la Cruz
- Department of Neonatal and Pediatric Surgery, Instituto Nacional de Salud del Niño San Borja, Lima, Peru
| | - Victor Trigoso
- Department of Neonatal and Pediatric Surgery, Instituto Nacional de Salud del Niño San Borja, Lima, Peru
| | - Carmen Cerron-Vela
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Luis De la Torre-Mondragon
- International Center for Colorectal and Genitourinary Care, Children's Hospital Colorado, Denver, CO, USA
| |
Collapse
|
16
|
Chi Y, Chen W, Ming A, Hao X, Gao R, Li S, Ye S, Zhou Y, Li L. Transurachal Catheter for Management of Difficult Catheterization in Anorectal Malformations: A Novel Technique. J Pediatr Surg 2024:S0022-3468(24)00070-8. [PMID: 38403490 DOI: 10.1016/j.jpedsurg.2024.01.038] [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: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Urinary tract drainage is necessary to facilitate the maneuver in laparoscopic-assisted anorectoplasty (LAARP). Male patients with Anorectal malformations (ARM) are often encounter difficult catheterization during surgery. OBJECTIVE We pioneered the urinary catheterization through the urachus in ARM patients and evaluated the efficacy. METHOD Fourteen ARM patients undergoing urinary catheterization through urachus between September 2015 and September 2023 were reviewed. RESULTS The median age at the time of surgery was 0.06 months. Nine neonatal patients underwent the one-stage LAARP, while five patients underwent staged procedure. Four ARM patients with rectoprostatic fistula, while ten with rectobulbar fistula. All patients successfully underwent transurachal catheterization. No incidents of catheter blockage, accidental removal, or urinary tract infection symptoms were detected during hospitalization. CONCLUSIONS Transurachal catheterization is a safe, effective, and cosmetic procedure for ARM patients with difficulty urethral catheterization. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Yidi Chi
- Department of Pediatric Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Wei Chen
- Department of Pediatric Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Anxiao Ming
- Department of Pediatric Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China; Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
| | - Xianhua Hao
- Department of Pediatric Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Ruyue Gao
- Department of Pediatric Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Siqi Li
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
| | - Shiru Ye
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
| | - Yan Zhou
- Department of Pediatric Surgery, Capital Institute of Pediatrics, Beijing, China
| | - Long Li
- Department of Pediatric Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.
| |
Collapse
|
17
|
Lu C, Pan S, Chen H, Tang W. Bowel function and features of bowel dysfunction in preschool children with anorectal malformation type rectoperineal and rectovestibular fistula. Eur J Pediatr 2024; 183:599-610. [PMID: 37935997 DOI: 10.1007/s00431-023-05306-4] [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] [Received: 09/16/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/09/2023]
Abstract
Anorectal malformations (ARMs) of the rectoperineal and rectovestibular fistula type (RPF/RVF) generally have a good prognosis but may be accompanied by bowel dysfunction, especially constipation. Bowel dysfunction in preschoolers may persist into adolescence and adulthood, exerting a negative effect on their quality of life. This study was designed to evaluate bowel function and identify the features of bowel dysfunction in preschoolers with RPF/RVF across type and sex differences. A total of 159 preschoolers with RPF/RVF (male RPF group, n = 95; female RPF group, n = 26; RVF, n = 38) and 128 normal control preschoolers (control group, n = 128; female control group, n = 35), according to the bowel function score (BFS) obtained through a questionnaire survey, the BFS items in the questionnaire, and the clinical characteristics of patients were compared among groups. The rates of bowel dysfunction (BFS < 17) were 27.2% and 50.0% in the RPF and RVF groups, respectively. Normal rates of BFS items, namely, ability to hold back defecation, feels/reports of the urge to defecate, frequency of defecation, and constipation, in the RPF and RVF groups were significantly lower than those in the control and female control groups (all p < 0.05). After subgroup analysis among the male RPF, female RPF, and RVF groups, higher rates of normal bowel function and ability to hold back defecation were found in the male RPF group than in the female RPF and RVF groups (p < 0.05). Normal rates of feels/reports of the urge to defecate were higher in the male and female RPF groups than in the RVF group (all p < 0.05). The rate of never soiling in the male RPF group was significantly higher than that in the RVF group (p < 0.05). Conclusions: In patients with RPF/RVF, bowel dysfunction is still prevalent, characterized by inadequate ability to hold back defecation, inability to feel/report the urge to defecate, soil, less frequent defecation, and constipation. However, male RPF patients had better overall bowel function than female RPF or RVF patients, including more adequate ability to hold back defecation and feels/reports of the urge to defecate and slighter soiling, which may be linked to early age at surgery, low occurrences of low sacral ratio, and tethered cord in male RPF. Trial registration: This study was retrospectively registered in ClinicalTrials.gov on 09/01/2023 (NCT05716230). What is Known: • Rectoperineal and rectovestibular fistula (RPF/RVF) of the anorectal malformation (ARM) type has a good prognosis but may cause bowel dysfunction, especially constipation. • Bowel dysfunction at preschool age may lead to social and psychological disorders that undermine the quality of life in adolescence and adulthood. What is New: • Bowel function in preschoolers with RPF/RVF was deeply evaluated in a relatively large number of patients and normal control children. • Features of bowel dysfunction in RPF/RVF preschoolers across type and gender differences were identified in this study.
Collapse
Affiliation(s)
- Changgui Lu
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Shiwen Pan
- Department of Anaesthesia and Operation, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Huan Chen
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
| | - Weibing Tang
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
| |
Collapse
|
18
|
Shen ZY, Zhang Y, Tao CH, Wang DJ, Zhang ZB, Zhang SC. A Predictive Model to Identify the Effects of Transcutaneous Sacral Nerve Stimulation With Pelvic Floor Exercises in Fecal Incontinence After Surgery for Anorectal Malformation. Am J Gastroenterol 2024; 119:191-199. [PMID: 37787428 DOI: 10.14309/ajg.0000000000002544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/22/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Although the combination of transcutaneous sacral nerve stimulation (tSNS) and pelvic floor exercises (PFEs) has shown significant effectiveness in treating fecal incontinence (FI) after surgery for congenital anorectal malformation (CARM), not all patients achieve satisfactory continence. Therefore, identifying which individuals will benefit from this method is crucial. METHODS A prospective cohort study enrolled 92 children with FI. All patients underwent tSNS with PFE treatment, and an improved outcome was defined as a Wexner score ≤4. A predictive model to identify the effects of tSNS with PFEs in FI was developed based on the analysis of magnetic resonance imaging and high-resolution anorectal manometry with area under the receiver-operating characteristic curve to evaluate the predictive value of external anal sphincter (EAS) thickness index and anal squeezing pressure (ASP). RESULTS tSNS with PFEs improved outcomes in 72 patients and led to poor outcomes in 20 (4 had their rectums deviate from the puborectalis muscle center or puborectal muscle ruptures while 16 lacked EAS with a lower ASP). The areas under the receiver-operating characteristic curve for EAS thickness index and ASP in predicting the effects of tSNS with PFEs were 0.915 (95% confidence interval 0.846-0.983, P = 0.000) and 0.886 (95% confidence interval 0.819-0.952, P = 0.000), respectively. By applying cutoff values of 0.076 for EAS thickness index and 21.95 mm Hg for ASP, tSNS with PFEs was found to be ineffective. DISCUSSION tSNS with PFEs is effective for most patients with FI after CARM surgery, except when the rectum deviates from the puborectal muscle center, puborectal muscle rupture occurs, or EAS is absent with a low ASP.
Collapse
Affiliation(s)
- Zhe-Ying Shen
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yao Zhang
- Department of Ultrasound, Shengjing Hospital of China Medical University, Shenyang, China
| | - Chun-Hong Tao
- Department of Obstetrics and Gynecology, 962 Hospital of PLA Joint Logistic Support Force, Harbin, China
| | - Da-Jia Wang
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhi-Bo Zhang
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Shu-Cheng Zhang
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| |
Collapse
|
19
|
Liu YS, Zhu HW, Wang Y, Ma D. Analysis of postoperative complications in children treated for moderate to severe anal atresia with laparoscopic versus open surgery: A retrospective study. Medicine (Baltimore) 2023; 102:e36744. [PMID: 38206727 PMCID: PMC10754549 DOI: 10.1097/md.0000000000036744] [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] [Received: 08/15/2023] [Accepted: 11/30/2023] [Indexed: 01/13/2024] Open
Abstract
This study aimed to compare and analyze the postoperative complications and anal function after 3-stage laparoscopic-assisted anorectoplasty (LAARP) and conventional posterior sagittal anorectoplasty (PSARP) in the treatment of moderate to severe anal atresia in children. A total of 27 children with moderate to severe anal atresia who underwent conventional PSARP at the Dongguan Children Hospital between 2007 and 2011 were included in the control group, and 34 children with moderate to severe anal atresia who underwent 3-stage LAARP between 2012 and 2016 were included in the observation group. The incidence of postoperative complications and Kelly score of anal function in the 2 groups were statistically analyzed and the efficacy of the 2 procedures compared. The incidence of postoperative complications such as wound infection, anal stenosis, anastomotic leakage, fecal incontinence, and constipation in the LAARP group was lower as compared with the PSARP group, and there was a statistically significant difference (P < .05). There was no significant difference in the incidence of postoperative complications such as rectal prolapse, diarrhea, and recurrent fistula between the LAARP group and the PSARP group (P > .05). The Kelly score of anal function was higher in the LAARP group than in the PSARP group, and the difference was statistically significant (P < .05). Compared to conventional PSARP, laparoscopic surgery for moderate to severe anal atresia in children has less complications, improved anal function, and a clear therapeutic impact.
Collapse
Affiliation(s)
- Ying-Song Liu
- Department of Pediatric Surgery, Dongguan Children’s Hospital, Dongguan, China
| | - Hai-Wei Zhu
- Department of Pediatric Surgery, Dongguan Children’s Hospital, Dongguan, China
| | - Yi Wang
- Department of Pediatric Surgery, Dongguan Children’s Hospital, Dongguan, China
| | - Da Ma
- Department of Pediatric Surgery, Dongguan Children’s Hospital, Dongguan, China
| |
Collapse
|
20
|
Ho E, Noori J, Behrenbruch C, Johnston M. Delayed diagnosis of congenital anorectal malformation. ANZ J Surg 2023; 93:3023-3024. [PMID: 37727037 DOI: 10.1111/ans.18691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 08/29/2023] [Indexed: 09/21/2023]
Affiliation(s)
- Elise Ho
- Department of Colorectal Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Jawed Noori
- Department of Colorectal Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Corina Behrenbruch
- Department of Colorectal Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
- The University of Melbourne, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Michael Johnston
- Department of Colorectal Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| |
Collapse
|
21
|
Karlsen RA, Hoel AT, Gjone H, Bjørnland K. Nurses' Experiences With Anal Dilatations in Babies With Anorectal Malformations - A Focus Group Interview Study. J Pediatr Surg 2023; 58:1929-1934. [PMID: 37246043 DOI: 10.1016/j.jpedsurg.2023.04.021] [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] [Received: 01/03/2023] [Revised: 04/12/2023] [Accepted: 04/25/2023] [Indexed: 05/30/2023]
Abstract
AIMS AND OBJECTIVES To explore nurses' experiences with anal dilatations in babies with anorectal malformations. BACKGROUND Most babies with anorectal malformations require repeated anal dilatations, either before and/or after reconstructive surgery. Anal dilatation is usually performed without sedation or pain medication. Nurses participate in anal dilatations by assisting doctors doing anal dilatation, doing anal dilatation themselves, and instructing parents how to do anal dilatations. No previous studies have explored how nurses experience being involved in anal dilatations. DESIGN Qualitative study design utilizing focus group interviews. The COREQ guidelines were applied. METHODS Nurses with either ≤2 or ≥10 years' working experience participated in two different focus group interviews. The focus group interviews were transcribed and analyzed with content analysis. RESULTS Twelve nurses, two males, participated. Three main themes emerged from the focus group interviews. The first main theme, "Anal dilatation causes distress", describes the nurses' worries about causing physical and/or psychological harm when doing anal dilatations. The second main theme, "Need for guidelines and training", contains nurses' recommendations for more theoretical training in addition to written guidelines on anal dilatations. The third main theme, "Collegial support is vital", describes nurses' needs and strategies for coping with difficult situations related to anal dilatations. CONCLUSIONS Anal dilatation causes distress in nurses, and collegial support is essential for coping. Guidelines and systematic training are recommended to improve current practice. LEVEL OF EVIDENCE VI.
Collapse
Affiliation(s)
| | - Anders Telle Hoel
- University of Oslo, Oslo, Norway; Department of Pediatric Surgery, Oslo University Hospital, Oslo, Norway
| | - Helene Gjone
- Department of Child and Adolescent Mental Health in Hospitals, Oslo University Hospital, Oslo, Norway
| | - Kristin Bjørnland
- University of Oslo, Oslo, Norway; Department of Pediatric Surgery, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
22
|
Bai J, Zhang B, Lin K. Preoperative fistula diagnostics in male anorectal malformations after colostomy: a single-center experience. BMC Med Imaging 2023; 23:139. [PMID: 37749545 PMCID: PMC10521448 DOI: 10.1186/s12880-023-01105-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/20/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Accurate preoperative fistula diagnostics in male anorectal malformations (ARM) after colostomy are of great significance. We reviewed our institutional experiences and explored methods for improving the preoperative diagnostic accuracy of fistulas in males with ARMs after colostomy. METHODS A retrospective analysis was performed on males with ARMs after colostomy admitted to our hospital from January 2015 to June 2022. All patients underwent magnetic resonance imaging (MRI) and high-pressure colostogram (HPC) before anorectal reconstruction. Patients with no fistula as diagnosed by both modalities underwent a voiding cystourethrogram (VCUG). General information, imaging results and surgical results were recorded. RESULTS Sixty-nine males with ARMs after colostomy were included. Age at the time of examination was 52 ~ 213 days, and the median age was 89 days. The Krickenbeck classification according to surgical results included rectovesical fistula (n = 19), rectoprostatic fistula (n = 24), rectobulbar fistula (n = 19) and no fistula (n = 7). There was no significant difference in the diagnostic accuracy between MRI and HPC for different types of ARMs. For determining the location of the fistula, compared to surgery, HPC (76.8%, 53/69) performed significantly better than MRI (60.9%, 42/69) (p = 0.043). Sixteen patients diagnosed as having no fistula by MRI or HPC underwent a VCUG, and in 14 patients, the results were comfirmed. However, there were 2 cases of rectoprostatic fistula that were not correctly diagnosed. CONCLUSION High-pressure colostogram has greater accuracy than MRI in the diagnosis of fistula type in males with ARMs after colostomy. For patients diagnosed with no fistula by both methods, VCUG reduces the risk of false-negative exclusion, and rectoprostatic fistula should be considered during the operation.
Collapse
Affiliation(s)
- Jianxi Bai
- Pediatric Surgery Department, Fujian Children's Hospital, Fuzhou City, Fujian Province, China
- Pediatric Surgery Department, Fujian Branch of Shanghai Children's Medical Center, Fuzhou City, Fujian Province, China
- Pediatric Surgery Department, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou City, Fujian Province, China
| | - Bing Zhang
- Pediatric Surgery Department, Fujian Children's Hospital, Fuzhou City, Fujian Province, China
- Pediatric Surgery Department, Fujian Branch of Shanghai Children's Medical Center, Fuzhou City, Fujian Province, China
- Pediatric Surgery Department, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou City, Fujian Province, China
| | - Kaiwu Lin
- Radiology Department, Fujian Provincial Maternity and Children Hospital, 18 Daoshan Road, Gulou District, Fuzhou City, Fujian Province, China.
| |
Collapse
|
23
|
Li SY, Wang CY, Wei XG, Tang XB, Yuan ZW, Bai YZ. CircJag1 promotes apoptosis of ethylene thiourea-exposed anorectal malformations through sponging miR-137-3p by regulating Sox9 and suppressing Wnt/β-catenin pathway during the hindgut development of rat embryos. Cell Biol Toxicol 2023; 39:1593-1610. [PMID: 35930101 DOI: 10.1007/s10565-022-09750-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022]
Abstract
Anorectal malformations (ARMs) are common birth defects involving congenital structural anomalies of the gastrointestinal tract. As an important component of non-coding RNAs, circular RNAs (circRNAs) widely participate in the digestive system development; however, the specific molecular mechanism of their involvement in ARM occurrence remains obscure. Herein, we generated rat models of ARMs induced by ethylene thiourea. A novel circRNA (circJag1) was screened and identified by RNA-Seq, which is remarkably upregulated in hindgut tissues of ARM rat embryos. In vivo experiments, colocation analysis via fluorescence in situ hybridization, and immunofluorescence further demonstrated that the disordered circJag1/miR-137-3p/Sox9 expression caused a spatiotemporal imbalance in the urorectal septum (URS) of ARMs. In vitro, functional assays confirmed that circJag1 upregulation resulted in the degradation of nuclear β-catenin, C-myc, and Cyclin D1 in rat intestinal epithelial cells, as well as the promotion of apoptosis and suppression of cell proliferation. Mechanistically, dual-luciferase reporter assay and RNA immunoprecipitation assay indicated that circJag1 acted as a miR-137-3p sponge, thereby inhibiting its repressive effect on its target Sox9. Further experiments showed that a loss of Sox9 abolished the circJag1-mediated increase in apoptosis. In conclusion, aberrantly high circJag1 expression promotes epithelial apoptosis by suppressing the canonical Wnt/β-catenin pathway via the miR-137-3p/Sox9 axis, which leads to fusion failure of the URS and cloacal membrane, and eventually contributed to ARMs. Our achievements might boost the comprehension of ARM pathogenesis and could provide a novel candidate target for the development of therapies for ARMs to complement surgical treatment.
Collapse
Affiliation(s)
- Si Ying Li
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Chen Yi Wang
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Xiao Gao Wei
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Xiao Bing Tang
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Zheng Wei Yuan
- Key Laboratory of Health Ministry for Congenital Malformation, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China
| | - Yu Zuo Bai
- Department of Pediatric Surgery, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang, 110004, Liaoning, China.
| |
Collapse
|
24
|
Singh RJ, Suman BK, Sinha AK, Kumar B. Neonatal Sigmoid Colon Perforation in Low Anorectal Malformation. J Indian Assoc Pediatr Surg 2023; 28:342-344. [PMID: 37635885 PMCID: PMC10455714 DOI: 10.4103/jiaps.jiaps_36_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/07/2023] [Accepted: 04/13/2023] [Indexed: 08/29/2023] Open
Abstract
Anorectal malformations (ARMs) are common congenital anomalies in neonates. Colonic perforation is very rare in ARMs. Delay in diagnosis of neonate with ARM results in colonic perforations and life-threatening morbidity. Colonic perforation due to ARM may not be completely avoided; however, early diagnosis and management are essential in assuring better outcomes.
Collapse
Affiliation(s)
| | | | | | - Bindey Kumar
- Department of Pediatric Surgery, AIIMS, Patna, Bihar, India
| |
Collapse
|
25
|
Zhao J, Zhang Y, Xiong Y, Du J, Chen Y, Guo W, Huang J. Three dimension high definition manometry evaluated postoperative anal canal functions in children with congenital anorectal malformations. Front Pediatr 2023; 11:1126373. [PMID: 37397140 PMCID: PMC10311638 DOI: 10.3389/fped.2023.1126373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Accepted: 06/05/2023] [Indexed: 07/04/2023] Open
Abstract
Background We aimed to evaluate the function of the reconstructed anal canal in postoperative anorectal malformations (ARMs) patients through three dimension (3D) high-definition anorectal manometry. Methods From January 2015 to December 2019, 3D manometry was performed as a postoperative functional assessment of patients with ARMs divided into age subgroups based on the time of manometry. Manometric parameters, such as the length of the anorectal high-pressure zone (HPZ-length), the mean resting and squeeze pressure of HPZ (HPZ-rest and HPZ-sqze), recto-anal inhibitory reflex (RAIR), and strength distribution of the anal canal, were collected and compared with age-matched controls. Their functional outcomes were analyzed with SPSS 23.0 software for statistical analysis. Results 171 manometric measurements were performed on 142 postoperative patients (3 months∼15 years). The HPZ-rest in all patients was significantly lower than in age-matched controls (p < 0.05). HPZ-sqze was notably decreased in patients older than 4 years, whereas other age groups were comparable to controls (p < 0.05). The proportions of asymmetric strength distribution and negative RAIR were higher in ARMs patients. The type of anorectal malformations and lower HPZ-rest were the impact factors affecting postoperative functional outcomes. Conclusions The majority of the ARMs patients had acceptable functional outcomes. 3D manometry can objectively assess the reconstructed anal canal function. The patients with fecal incontinence had a high proportion of extremely low HPZ-rest and HPZ-sqze, negative RAIR, and asymmetric strength distribution. The manometric details will help the clinicians explore the causes of defecation complications and guide further management.
Collapse
|
26
|
Bokova E, Svetanoff WJ, Lopez JJ, Levitt MA, Rentea RM. State of the Art Bowel Management for Pediatric Colorectal Problems: Anorectal Malformations. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050846. [PMID: 37238394 DOI: 10.3390/children10050846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/28/2023] [Accepted: 05/04/2023] [Indexed: 05/28/2023]
Abstract
Up to 79% of patients with anorectal malformations (ARMs) experience constipation and/or soiling after a primary posterior sagittal anoplasty (PSARP) and are referred to a bowel management program. We aim to report the recent updates in evaluating and managing these patients as part of the manuscript series on the current bowel management protocols for patients with colorectal diseases (ARMs, Hirschsprung disease, functional constipation, and spinal anomalies). The unique anatomic features of ARM patients, such as maldeveloped sphincter complex, impaired anal sensation, and associated spine and sacrum anomalies, indicate their bowel management plan. The evaluation includes an examination under anesthesia and a contrast study to exclude anatomic causes of poor bowel function. The potential for bowel control is discussed with the families based on the ARM index calculated from the quality of the spine and sacrum. The bowel management options include laxatives, rectal enemas, transanal irrigations, and antegrade continence enemas. In ARM patients, stool softeners should be avoided as they can worsen soiling.
Collapse
Affiliation(s)
- Elizaveta Bokova
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA
| | - Wendy Jo Svetanoff
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Hospital, Kansas City, MO 64108, USA
| | - Joseph J Lopez
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy Hospital, 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 Hospital, Kansas City, MO 64108, USA
- Department of Surgery, University of Missouri-Kansas City, Kansas City, MO 64108, USA
| |
Collapse
|
27
|
Iantorno SE, Rollins MD, Austin K, Avansino JR, Badillo A, Calkins CM, Crady RC, Dickie BH, Durham MM, Frischer JS, Fuller MK, Grabowski JE, Ralls MW, Reeder RW, Rentea RM, Saadai P, Wood RJ, van Leeuwen KD, Short SS. Rectal Prolapse Following Repair of Anorectal Malformation: Incidence, Risk Factors, and Management. J Pediatr Surg 2023:S0022-3468(23)00252-X. [PMID: 37173214 DOI: 10.1016/j.jpedsurg.2023.04.010] [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: 04/17/2023] [Accepted: 04/18/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND The incidence and optimal management of rectal prolapse following repair of an anorectal malformation (ARM) has not been well-defined. METHODS A retrospective cohort study was performed utilizing data from the Pediatric Colorectal and Pelvic Learning Consortium registry. All children with a history of ARM repair were included. Our primary outcome was rectal prolapse. Secondary outcomes included operative management of prolapse and anoplasty stricture following operative management of prolapse. Univariate analyses were performed to identify patient factors associated with our primary and secondary outcomes. A multivariable logistic regression was developed to assess the association between laparoscopic ARM repair and rectal prolapse. RESULTS A total of 1140 patients met inclusion criteria; 163 (14.3%) developed rectal prolapse. On univariate analysis, prolapse was significantly associated with male sex, sacral abnormalities, ARM type, ARM complexity, and laparoscopic ARM repairs (p < 0.001). ARM types with the highest rates of prolapse included rectourethral-prostatic fistula (29.2%), rectovesical/bladder neck fistula (28.8%), and cloaca (25.0%). Of those who developed prolapse, 110 (67.5%) underwent operative management. Anoplasty strictures developed in 27 (24.5%) patients after prolapse repair. After controlling for ARM type and hospital, laparoscopic ARM repair was not significantly associated with prolapse (adjusted odds ratio (95% CI): 1.50 (0.84, 2.66), p = 0.17). CONCLUSION Rectal prolapse develops in a significant subset of patients following ARM repair. Risk factors for prolapse include male sex, complex ARM type, and sacral abnormalities. Further research investigating the indications for operative management of prolapse and operative techniques for prolapse repair are needed to define optimal treatment. TYPE OF STUDY Retrospective cohort study. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Stephanie E Iantorno
- Department of Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA.
| | - Michael D Rollins
- Department of Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| | - Kelly Austin
- Department of Surgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jeffrey R Avansino
- Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Andrea Badillo
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, George Washington University, Washington, DC, USA
| | - Casey M Calkins
- Department of Surgery, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Rachel C Crady
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Belinda H Dickie
- Department of Surgery, Boston Children's Hospital, Harvard University, Boston, MA, USA
| | - Megan M Durham
- Emory + Children's Pediatric Institute, Atlanta, GA, USA
| | - Jason S Frischer
- Department of Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA
| | - Megan K Fuller
- Department of Surgery, Boys Town Research Hospital-Children's of Omaha, University of Nebraska Medical Center, Boys Town, NE, USA
| | - Julia E Grabowski
- Department of Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA
| | - Matthew W Ralls
- Department of Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Ron W Reeder
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Rebecca M Rentea
- Department of Surgery, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA
| | - Payam Saadai
- Department of Surgery, UC Davis Children's Hospital, University of California Davis, Davis, CA, USA
| | - Richard J Wood
- Department of Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA
| | - Kathleen D van Leeuwen
- Department of Surgery, Phoenix Children's Hospital, University of Arizona, Phoenix, AZ, USA
| | - Scott S Short
- Department of Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
28
|
Rice-Townsend SE, Nicassio L, Glazer D, Avansino J, Durham MM, Frischer J, Calkins C, Rentea RM, Ralls M, Fuller M, Wood RJ, Rollins M, Lee J, Lewis KE, Reeder RW, Smith CA. Fecal continence outcomes and potential disparities for patients with anorectal malformations treated at referral institutions for pediatric colorectal surgery. Pediatr Surg Int 2023; 39:157. [PMID: 36952009 DOI: 10.1007/s00383-023-05447-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE Fecal incontinence is a problem for many patients born with an anorectal malformation (ARM) that can impact quality of life. It is unknown if racial, ethnic, and socioeconomic disparities relate to fecal continence in these children. We sought to examine outcomes and potential disparities in care. METHODS We performed a multicenter retrospective study of children > 3y with ARM evaluated at sites participating in the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC). The primary outcome was fecal continence. We evaluated for associations between fecal continence and race, sex, age, and insurance status. RESULTS 509 patients with ARM from 11 institutions were included. Overall, 24% reported complete fecal continence, and fecal continence was associated with older age (p < .001). For school-aged children, 27% reported complete continence, while 53% reported none. On univariate analysis, patients with combined private and public insurance showed lower rates of continence when compared to those with private insurance (23 vs. 12%; p = 0.02). Age was associated with continence on univariate and multivariable analyses. CONCLUSION Rates of complete fecal continence in this population are low. Differences based on payor status may exist. There were no observed disparities related to sex and race. Further investigation is warranted to improve care for this patient population. LEVEL OF EVIDENCE III. TYPE OF STUDY Multi-institutional retrospective comparative study.
Collapse
Affiliation(s)
- Samuel E Rice-Townsend
- Seattle Children's Hospital, University of Washington, OA.9.220, PO Box 5371, Seattle, WA, 98145-5005, USA.
| | - Lauren Nicassio
- Seattle Children's Hospital, University of Washington, OA.9.220, PO Box 5371, Seattle, WA, 98145-5005, USA
| | - Deb Glazer
- Seattle Children's Hospital, University of Washington, OA.9.220, PO Box 5371, Seattle, WA, 98145-5005, USA
| | - Jeffrey Avansino
- Seattle Children's Hospital, University of Washington, OA.9.220, PO Box 5371, Seattle, WA, 98145-5005, USA
| | - Megan M Durham
- Children's Healthcare of Atlanta, Emory University Pediatric Institute, Atlanta, GA, USA
| | | | - Casey Calkins
- Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | | | | | | | | | | | - Justin Lee
- Phoenix Children's Hospital, Phoenix, AZ, USA
| | | | | | - Caitlin A Smith
- Seattle Children's Hospital, University of Washington, OA.9.220, PO Box 5371, Seattle, WA, 98145-5005, USA
| | | |
Collapse
|
29
|
Belanger Deloge R, Zhao X, Luna PN, Shaw CA, Rosenfeld JA, Scott DA. High molecular diagnostic yields and novel phenotypic expansions involving syndromic anorectal malformations. Eur J Hum Genet 2023; 31:296-303. [PMID: 36474027 PMCID: PMC9995493 DOI: 10.1038/s41431-022-01255-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 11/04/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
Evidence suggests that genetic factors contribute to the development of anorectal malformations (ARMs). However, the etiology of the majority of ARMs cases remains unclear. Exome sequencing (ES) may be underutilized in the diagnostic workup of ARMs due to uncertainty regarding its diagnostic yield. In a clinical database of ~17,000 individuals referred for ES, we identified 130 individuals with syndromic ARMs. A definitive or probable diagnosis was made in 45 of these individuals for a diagnostic yield of 34.6% (45/130). The molecular diagnostic yield of individuals who initially met criteria for VACTERL association was lower than those who did not (26.8% vs 44.1%; p = 0.0437), suggesting that non-genetic factors may play an important role in this subset of syndromic ARM cases. Within this cohort, we identified two individuals who carried de novo pathogenic frameshift variants in ADNP, two individuals who were homozygous for pathogenic variants in BBS1, and single individuals who carried pathogenic or likely pathogenic variants in CREBBP, EP300, FANCC, KDM6A, SETD2, and SMARCA4. The association of these genes with ARMs was supported by previously published cases, and their similarity to known ARM genes as demonstrated using a machine learning algorithm. These data suggest that ES should be considered for all individuals with syndromic ARMs in whom a molecular diagnosis has not been made, and that ARMs represent a low penetrance phenotype associated with Helsmoortel-van der Aa syndrome, Bardet-Biedl syndrome 1, Rubinstein-Taybi syndromes 1 and 2, Fanconi anemia group C, Kabuki syndrome 2, SETD2-related disorders, and Coffin-Siris syndrome 4.
Collapse
Affiliation(s)
- Raymond Belanger Deloge
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Xiaonan Zhao
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, 77030, USA
- Baylor Genetics, Houston, TX, USA
| | - Pamela N Luna
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Chad A Shaw
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Jill A Rosenfeld
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Daryl A Scott
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, TX, 77030, USA.
- Department of Molecular Physiology and Biophysics, Baylor College of Medicine, Houston, TX, 77030, USA.
| |
Collapse
|
30
|
Lu C, Pan S, Hua X, Jiang W, Tang W. Bowel function at preschool and early childhood age in children with long-segment Hirschsprung disease. Eur J Pediatr 2023; 182:1251-1259. [PMID: 36633657 DOI: 10.1007/s00431-023-04814-7] [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] [Received: 11/27/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 01/13/2023]
Abstract
Bowel dysfunction has been proven to be the most typical complication of long-segment Hirschsprung disease (LSHD). Additionally, bowel dysfunction in preschool and early childhood should be properly assessed, because it may result in persistent bowel dysfunction, social issues, and depression in adolescence and adulthood. This study evaluated bowel function during preschool and early childhood in patients with LSHD. A cross-sectional bowel function score (BFS) questionnaire survey was conducted on 270 infants with short-segment Hirschsprung disease (SSHD) and LSHD who underwent pull-through (PT) between January 2014 and December 2019 at the Children's Hospital of Nanjing Medical University. One hundred ninety patients who consented to the survey were asked to complete the questionnaire and were divided into two groups: the LSHD group (n = 42) and the SSHD group (n = 148). Bowel function outcomes were assessed by using a questionnaire. The total BFS score in the LSHD group was significantly lower than that in the SSHD group (15.0 [14.0, 17.0] vs. 18.0 [16.0, 19.0], p < 0.05) and did not improve with age (p > 0.05). Independent BFS items with lower scores were discovered in LSHD than in SSHD, including the capacity to hold back defecation, feeling/reporting the urge to defecate, frequency, soiling, and accidents (all p < 0.05). After subgroup analysis of follow-up age (3-5 years, 5 ~ 7 years, and > 7 years), there was no difference between the score of ability to hold back defecation over 7 years old and feeling/reporting the urge to defecate over 5 years old (all p > 0.05). The frequency and soiling scores were lower in the LSHD group than in the SSHD group over 5 years of age (all p < 0.05). Fortunately, there was no difference in constipation scores and social problems between the LSHD and SSHD groups in every sub-follow-up group (all p > 0.05). Conclusion: Overall, bowel function at preschool and early childhood age was poorer in LSHD than in SSHD and did not improve with age. However, the ability to hold back defecation and feeling/reporting the urge to defecate with age in LSHD may be similar to those in SSHD. Simultaneously, the frequency, soiling, and number of accidents were consistently worse in the LSHD group. Trial registration: This study was retrospectively registered in the ClinicalTrials database.gov (NCT05461924) in August 2022. What is Known: • Bowel function in SSHD is satisfactory or near-normal, and the general consensus is that the longer the aganglionic segment, the worse the bowel function after surgery. • Bowel functional outcomes of LSHD were not defined, and the limited reports of bowel functional outcomes compared with SSHD were extensively varied. Bowel dysfunction at preschool and early childhood may lead to persistent bowel dysfunction, social problems, and depression in adolescence or adulthood. What is New: • Bowel function in preschool and early childhood in patients with LSHD has not been defined and should be thoroughly assessed in a larger group of patients with precise definitions of incontinence or soiling. • The present study was primarily designed to evaluate bowel function at preschool and early childhood age in LSHD compared with SSHD in a relatively large number of HD cases using BFS.
Collapse
Affiliation(s)
- Changgui Lu
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Shiwen Pan
- Department of Anesthesia and Operation, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Xinyi Hua
- Nanjing Medical University, Nanjing, 210008, China
| | - Weiwei Jiang
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
| | - Weibing Tang
- Department of Pediatric Surgery, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
| |
Collapse
|
31
|
Yuan P, Feng W, Huang Y, Wang Y. Prediction of anorectal malformations with bladder-neck/urethral-prostatic fistula using classification and regression tree analysis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:436-444. [PMID: 36200652 DOI: 10.1002/jcu.23355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 07/31/2022] [Accepted: 08/15/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The anorectal malformations (ARMs) with bladder-neck/urethral-prostatic fistula in males are the most complex groups in ARMs. It is essential to diagnose them effectively before the primary operation for both surgical modalities and future functional prognosis can be quite different from other types. Our study aimed to develop a classification and regression tree (CART) model for the prediction of ARMs with bladder-neck/urethral-prostatic fistula. METHODS A total of 132 newborns with ARMs were included retrospectively and randomly assigned to the training sample and test sample in a 3:1 ratio. The pouch-perineum distance of ultrasound (PPDU), the pouch-perineum distance of invertogram (PPDI), and the rectum gas above the coccyx (RGAC) on the invertogram were hypothesized can serve as individual predictors. The CART analysis was used to determine the best combination of candidate predictors. The model's performance was assessed by the area under the receiver operating characteristic curve (AUC) and validated in the test sample. RESULTS All three individual predictors were included in the CART model to predict the ARMs with bladder-neck/urethral-prostatic fistula in the derivation cohort with the following test characteristics (95% CI): sensitivity 75.6% (60.1 to 86.6); specificity 88.9% (76.7 to 95.4); AUC 0.909 (0.854 to 0.965). The model's predicted accuracy was validated in the test cohort (AUC = 0.883). In all 132 subjects, the AUC of the tree model was significantly superior to that of the best individual index: PPDU (0.901 vs. 0.819; p = 0.005). CONCLUSIONS A predictive model that consists of PPDU, PPDI, and RGAC may be useful in predicting ARMs with bladder-neck/urethral-prostatic fistula.
Collapse
Affiliation(s)
- Peng Yuan
- Department of Neonatal Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Wei Feng
- Department of Neonatal Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yao Huang
- Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yi Wang
- Department of Neonatal Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China
| |
Collapse
|
32
|
Saving the perineal body-A modification of the posterior sagittal anorectoplasty. Pediatr Surg Int 2023; 39:71. [PMID: 36592252 DOI: 10.1007/s00383-022-05350-5] [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: 12/19/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND Wound dehiscence of the anocutaneous anastomosis and/or reconstructed perineal body is a feared perioperative complication after posterior sagittal anorectoplasty (PSARP). Dehiscence of the perineal body can have long-term negative implications for fecal continence, sexual intimacy, obstetrical outcomes, and the need for reoperative surgery. We describe a modification to the traditional PSARP for repair of an imperforate anus with a rectovestibular, perineal, or absent fistula by sparing the perineal body, eliminating postoperative perineal body dehiscence and potentially improving long-term functional outcomes. METHODS A retrospective review of female patients with a rectovestibular, perineal, or absent fistula who underwent PSARP with sparing of the perineal body was performed. RESULTS Six patients underwent PSARP with sparing of the perineal body between 2019 and 2022. There were no perioperative complications. At follow-up, all patients are having regular bowel function without difficulty and have an excellent appearance of their perineal body. CONCLUSIONS PSARP for a rectovestibular, perineal, or absent fistula can be safely performed with a more limited incision to avoid disruption of the perineal body. This eliminates the need for perineal body reconstruction during the procedure, thereby preventing wound dehiscence. Given the significant long-term adverse sequelae of wound dehiscence and resultant inadequate perineal body, we believe this modification to the PSARP warrants strong consideration.
Collapse
|
33
|
König TT, Krude M, Muensterer OJ. Physical self-concept and ability to swim in patients born with anorectal malformation and Hirschsprung's disease: a case control study. BMC Pediatr 2022; 22:717. [PMID: 36517764 PMCID: PMC9753325 DOI: 10.1186/s12887-022-03782-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Children with anorectal malformation (ARM) and Hirschsprung's Disease (HD) live with permanent urinary and bowel symptoms, possibly impairing motor development in early childhood. Not being able to swim adds an unnecessary health risk. The aim of this study was to determine the ability to swim and physical self-concept in patients with ARM and HD. METHODS We performed an anonymous survey among the members of the national patient organization SoMA e.V. (6 through 25 years). A control group was recruited from our department. Ability to swim, symptom load according to Rintala Score and physical self-concept were recorded using validated questionnaires. Patients were matched with controls according to gender and age. Mean scores and 95%-confidence intervals (95%-CI) were calculated, χ2-test and multiple linear regression models were used as appropriate. RESULTS Totally, 83 match-control-pairs were included. Patients learned to swim at a similar age and rate (6.5 years, 95%-CI: 6.1-6.9, 74.7% swimmers) compared to controls (6.4 years, 95%-CI: 6.1-6.8, 79.5% swimmers, p = 0.46). VACTERL patients had a significantly lower swimmer rate (59.1%, p = 0.048). Swimmers had a significantly higher mean Rintala Score (12.5, 95%-CI: 11.6-13.2) compared to non-swimmers (10.4, 95%-CI: 8.1-12.1, p = 0,049). In prepubertal children (6 through 12 years), no difference in physical self-concept was shown compared to controls. Adolescents and young adults with ARM/HD, especially females, had a significantly lower mean score for the subscales of flexibility, speed, endurance and sports competence, independent of bowel symptom load according to Rintala Score. CONCLUSIONS Patients with ARM/HD have normal swimming skills and a normal physical self-concept in childhood that decreases with age compared to peers. In adolescence, parents and health care professionals should actively promote physical activity in ARM/HD patients.
Collapse
Affiliation(s)
- Tatjana Tamara König
- grid.5802.f0000 0001 1941 7111Department of Pediatric Surgery Universitätsmedizin, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Mattis Krude
- grid.5802.f0000 0001 1941 7111Department of Pediatric Surgery Universitätsmedizin, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131 Mainz, Germany
| | - Oliver J. Muensterer
- grid.5252.00000 0004 1936 973XDepartment of Pediatric Surgery, Ludwig-Maximilians-University Munich, Dr. Von Haunersches Kinderspital, Munich, Germany
| |
Collapse
|
34
|
Zhou Y, Ye S, Yang C, Gao R, Ming AX, Diao M, Li L. One-stage versus staged laparoscopic-assisted anorectoplasty for high-and intermediate anorectal malformations: Medium-term outcomes from a propensity score matching analysis. J Pediatr Surg 2022; 57:555-560. [PMID: 35151499 DOI: 10.1016/j.jpedsurg.2022.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 12/24/2021] [Accepted: 01/11/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND The timing of anorectoplasty for anorectal malformations (ARMs) is controversial and essential for long-term bowel function. The advantages of laparoscopy make primary anoplasty possible for neonates. This study aims to report the medium-term results of the one-stage laparoscopic-assisted anorectoplasty (LAARP) and compare them with the staged LAARP. METHODS This study included 242 boys who underwent LAARP between June 2013 and December 2018 in our center. Forty-five neonatal patients successfully underwent the one-stage LAARP, and the remaining 197 patients who had already undergone colostomy received staged procedures. The complications and bowel function were compared between the two groups after 1:1 propensity score matching (PSM). RESULTS Before matching, age at assessment and classification were significantly different between the two groups (P < 0.05). After PSM, 42 patients were included in each of the two groups, and the patients were well balanced. The overall occurrence of postoperative complications in the one-stage group was significantly lower than in the staged group (P < 0.05). The median follow-up periods were 55.0 and 54.5 months, respectively. The mean value of BFS was similar in the two groups. After medical management, a second evaluation was conducted to distinguish overflow pseudo-incontinence from patients with no bowel control potential. The functional outcome in the two groups is comparable (P = 0.307). CONCLUSIONS One-stage LAARP is safe and feasible for neonates with high-and intermediate-type ARMs. Compared with staged LAARP, one-stage LAARP has fewer complications and comparable functional outcomes. The authors recommend these procedures to be performed in dedicated centers with sufficient expertise. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Yan Zhou
- Department of Pediatric Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing 100020, People's Republic of China; Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China
| | - Shiru Ye
- Department of Pediatric Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing 100020, People's Republic of China
| | - Changzhen Yang
- Department of Pediatric Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing 100020, People's Republic of China; Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China
| | - Ruyue Gao
- Department of Pediatric Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing 100020, People's Republic of China; Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China
| | - An-Xiao Ming
- Department of Pediatric Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing 100020, People's Republic of China
| | - Mei Diao
- Department of Pediatric Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing 100020, People's Republic of China
| | - Long Li
- Department of Pediatric Surgery, Capital Institute of Pediatrics, No. 2 Yabao Road, Chaoyang District, Beijing 100020, People's Republic of China; Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, People's Republic of China.
| |
Collapse
|
35
|
Pitaka RT, Fauzi AR, Makhmudi A, Gunadi. Comparison and impact of associated anomalies on the anal position index in neonates with anorectal malformation. BMC Res Notes 2022; 15:294. [PMID: 36071457 PMCID: PMC9450298 DOI: 10.1186/s13104-022-06186-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/27/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Some prognostic factors have affected the functional outcomes of patients with anorectal malformations (ARM) after definitive surgery, including the associated anomalies. Moreover, the anal position index (API) study in neonates from developing countries is minimal. We aimed to (1) compare the API between neonates with ARM and controls; and (2) determine the impact of associated anomalies on the API in neonates with ARM. RESULTS We ascertained 68 subjects: 35 neonates with ARM and 33 controls. The API of neonates with ARM was similar to controls, either male or female neonates (p = 0.51 and 0.90, respectively). Interestingly, the API in ARM males with associated anomalies (0.42 ± 0.07) was significantly lower than in control males (0.48 ± 0.02) (p = 0.005). Moreover, the API of ARM neonates with vertebral anomalies (0.35 ± 0.04) was lower than ARM neonates without vertebral anomalies (0.47 ± 0.07) (p = 0.021). In conclusion, associated anomalies and sex might affect the API in neonates with ARM. These findings should be considered and informed during counseling to the parents regarding the prognosis of functional outcomes in ARM neonates, particularly with associated anomalies.
Collapse
Affiliation(s)
- Ririd Tri Pitaka
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Jl. Kesehatan No. 1, Yogyakarta, 55281, Indonesia
| | - Aditya Rifqi Fauzi
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Jl. Kesehatan No. 1, Yogyakarta, 55281, Indonesia
| | - Akhmad Makhmudi
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Jl. Kesehatan No. 1, Yogyakarta, 55281, Indonesia
| | - Gunadi
- Pediatric Surgery Division, Department of Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito Hospital, Jl. Kesehatan No. 1, Yogyakarta, 55281, Indonesia.
| |
Collapse
|
36
|
Bhalla RG, Li B, Adams MC, Neblett WW, Thomas JC. Robotic-assisted laparoscopic repair of a congenital rectourethral fistula with duplicated urethra. J Pediatr Urol 2022; 18:404-405. [PMID: 35525825 DOI: 10.1016/j.jpurol.2022.04.013] [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: 02/09/2022] [Accepted: 04/13/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To describe our experience with robot-assisted laparoscopic transperitoneal repair of a congenital rectourethral fistula in a pediatric patient with a urethral duplication. METHODS The patient is a 2-year-old male with a past medical history of Tetralogy of Fallot presenting with a febrile urinary tract infection (UTI). He was diagnosed with urethral duplication and a rectourethral fistula by voiding cystourethrogram (VCUG). The parents were counseled on various options and agreed to proceed with a robotic repair. RESULTS Robotic-assisted transperitoneal rectourethral fistula repair was performed. The procedure time was 229 min with an estimated blood loss (EBL) of 15 mL. His postoperative course was unremarkable. At his 2-week follow-up, the urethral catheter was removed and the patient was voiding normally and having normal bowel movements. CONCLUSION Congenital rectourethral fistula with urethral duplication is a rare anomaly with only a few reports in the literature. Pediatric robotic-assisted transperitoneal rectourethral fistula repair is a technically feasible approach in infants with minimal morbidity that allows for excellent visualization and avoids open repair.
Collapse
Affiliation(s)
- Rohan G Bhalla
- Department of Urology, Vanderbilt University Medical Center, 1161 21st Ave. South, A-1302 Medical Center North, Nashville, TN 37232, USA.
| | - Belinda Li
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Division of Pediatric Urology, Nashville, TN, 37232, USA; Columbia University Irving Medical Center, Department of Urology, New York, NY 10032, USA.
| | - Mark C Adams
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Division of Pediatric Urology, Nashville, TN, 37232, USA.
| | - Wallace W Neblett
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Division of Pediatric Surgery, Nashville, TN, 37232, USA.
| | - John C Thomas
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Division of Pediatric Urology, Nashville, TN, 37232, USA.
| |
Collapse
|
37
|
Reddy M, Tank N, Bawa M, Kanojia RP, Samujh R. Anorectal Malformations: The Earlier the Diagnosis, the Better the Outcome. Indian J Pediatr 2022; 89:536-540. [PMID: 34553299 DOI: 10.1007/s12098-021-03887-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 06/07/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To estimate the impact of delayed presentation of anorectal malformation (ARM) in neonates and to compare the presenting characteristics and outcomes of early versus delayed presentation. METHODS This is a prospective observational study of all neonates (age < 28 d) with ARM over 2 y. Delayed presentation was defined as presentation beyond 48 h of birth. Various presenting features and their early postoperative outcomes were compared. RESULTS Nearly half (26, 48%) of the 54 neonates with ARM had delayed presentation. Early and late presenters did not differ in terms of gender, gestational age, birth weight, place of delivery, and type of ARM (p > 0.05 for all). Delayed group had lower weight at presentation (p = 0.008), higher incidence of severe abdominal distension (p = 0.05), and sepsis (p = 0.171) and required longer time for resuscitation (p = 0.007) and more inotropes (p = 0.015), preoperatively. Early postoperative outcomes including time for stoma to function, initiate feeds and time to reach full feeds were significantly delayed in late presenters. They also had more wound infections, longer hospital stay and higher mortality. CONCLUSIONS Delayed diagnosis of ARM is associated with significantly higher morbidity and mortality. Adequate awareness and training of health workers for early identification of ARM by careful perineal examination of all newborns at birth is the need of the hour.
Collapse
Affiliation(s)
- Manasa Reddy
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Nilesh Tank
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Monika Bawa
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Ravi P Kanojia
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Ram Samujh
- Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| |
Collapse
|
38
|
Sajankila N, DeRoss A, Lipman JM. Approach to the Adult Colorectal Patient with a History of Pediatric Abdominal Surgery. Clin Colon Rectal Surg 2022; 35:177-186. [PMID: 35966376 PMCID: PMC9374533 DOI: 10.1055/s-0042-1742412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Children with colorectal diseases often undergo operative management in their youth. As these patients become adult, it is important for surgeons to understand their postoperative anatomy as well as the pathophysiology of their diseases. Here, we present a description of common colorectal diseases of childhood that may have significant impact on patients' presentations as adult. We also discuss the diagnosis and management of conditions that are usually seen early in life but may present during adulthood as well.
Collapse
Affiliation(s)
- Nitin Sajankila
- Department of General Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Anthony DeRoss
- Department of Pediatric General Surgery, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Jeremy M. Lipman
- Department of Colorectal Surgery, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
| |
Collapse
|
39
|
Apte A, Mayhew A, McKenna E, Gomez-Lobo V, Levitt MA. Clinical Quiz—Newborn Female with an Anorectal Malformation and a Gynecological Abnormality. European J Pediatr Surg Rep 2022; 10:e63-e67. [PMID: 35433193 PMCID: PMC9008222 DOI: 10.1055/s-0041-1741508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 06/05/2021] [Indexed: 11/18/2022] Open
Abstract
We present a case of a newborn female with imperforate anus who on exam was found to have a rectal fistula in the vestibule, no vaginal opening, and a normal urethra. A diagnostic laparoscopy was performed to elucidate the internal anatomy. The case is presented with a focus on surgical strategies in approaching the female patient with anorectal malformation and a Mullerian anomaly, with questions for the readers posed in a quiz format.
Collapse
Affiliation(s)
- Anisha Apte
- Department of General Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, United States
| | - Allison Mayhew
- Department of Pediatric and Adolescent Gynecology, Children's National Medical Center, Washington, District of Columbia, United States
| | - Elise McKenna
- Department of General and Thoracic Surgery, Children's National Medical Center, Washington, District of Columbia, United States
| | - Veronica Gomez-Lobo
- Department of Pediatric and Adolescent Gynecology, Children's National Medical Center, Washington, District of Columbia, United States
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland, United States
| | - Marc A. Levitt
- Department of General and Thoracic Surgery, Children's National Medical Center, Washington, District of Columbia, United States
| |
Collapse
|
40
|
Islam T, Nusrat F, Islam MK, Hossain M. Anorectal malformation diverted with transverse colostomy associated with recurrent urinary tract infections. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
41
|
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: 27] [Impact Index Per Article: 13.5] [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.
Collapse
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.
| |
Collapse
|
42
|
Ludwig K, De Bartolo D, Salerno A, Ingravallo G, Cazzato G, Giacometti C, Dall’Igna P. Congenital anomalies of the tubular gastrointestinal tract. Pathologica 2022; 114:40-54. [PMID: 35212315 PMCID: PMC9040549 DOI: 10.32074/1591-951x-553] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 11/05/2022] [Indexed: 02/08/2023] Open
Abstract
Congenital anomalies of the tubular gastrointestinal tract are an important cause of morbidity not only in infants, but also in children and adults. The gastrointestinal (GI) tract, composed of all three primitive germ layers, develops early during embryogenesis. Two major steps in its development are the formation of the gut tube (giving rise to the foregut, the midgut and the hindgut), and the formation of individual organs with specialized cell types. Formation of an intact and functioning GI tract is under strict control from various molecular pathways. Disruption of any of these crucial mechanisms involved in the cell-fate decision along the dorsoventral, anteroposterior, left-right and radial axes, can lead to numerous congenital anomalies, most of which occur and present in infancy. However, they may run undetected during childhood. Therapy is surgical, which in some cases must be performed urgently, and prognosis depends on early diagnosis and suitable treatment. A precise pathologic macroscopic or microscopic diagnosis is important, not only for the immediate treatment and management of affected individuals, but also for future counselling of the affected individual and their family. This is even more true in cases of multiple anomalies or syndromic patterns. We discuss some of the more frequent or clinically important congenital anomalies of the tubular GI, including atresia's, duplications, intestinal malrotation, Meckel's diverticulum and Hirschsprung's Disease.
Collapse
Affiliation(s)
- Katrhin Ludwig
- Department of Pathology, Azienda Ospedale-Università Padova, Padua, Italy
| | - Debora De Bartolo
- Department of Medicine, University of Padua School of Medicine, Padua, Italy
| | - Angela Salerno
- Department of Oncology, Anatomic and Histologic Pathology and Cytodiagnostics, Maggiore Hospital, Bologna, Italy
| | - Giuseppe Ingravallo
- Department of Emergencies and Organ Transplantation, Section of Pathology, University of Bari, Bari, Italy
| | - Gerardo Cazzato
- Department of Emergencies and Organ Transplantation, Section of Pathology, University of Bari, Bari, Italy
| | - Cinzia Giacometti
- Department of Services, Pathology Unit, ULSS 6 “Euganea”, Camposampiero, Italy
| | - Patrizia Dall’Igna
- Department of Emergencies and Organ Transplantation, Pediatric Surgery, University of Bari, Bari, Italy
- Correspondence Patrizia Dall’Igna Department of Emergencies and Organ Transplantation, Azienda Ospedaliero-Universitaria Consorziale, Ospedale Pediatrico Giovanni XXIII, via Giovanni Amendola 207, 70126 Bari, Italy E-mail:
| |
Collapse
|
43
|
McKenna E, Ho C, Badillo A, Villalona G, Levitt MA. A Rare Case of Colonic Triplication with Associated Imperforate Anus in a Newborn Male. European J Pediatr Surg Rep 2022; 10:e118-e121. [PMID: 35992311 PMCID: PMC9381362 DOI: 10.1055/s-0042-1750318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/22/2022] [Indexed: 02/07/2023] Open
Abstract
AbstractWe present a case of a newborn male with imperforate anus who was found to have colonic triplication with a high rectovesical fistula. The case is presented with a focus on surgical strategies for the management of this rare malformation.
Collapse
Affiliation(s)
- Elise McKenna
- Department of Colorectal and Pelvic Reconstruction, Surgery, Children's National Hospital, Washington, District of Columbia, United States
| | - Christina Ho
- Department of Urology, Children's National Hospital, Washington, District of Columbia, United States
| | - Andrea Badillo
- Department of Colorectal and Pelvic Reconstruction, Surgery, Children's National Hospital, Washington, District of Columbia, United States
| | - Gustavo Villalona
- Department of Pediatric Surgery, Wolfson Children's Hospital, Jacksonville, Florida, United States
| | - Marc A. Levitt
- Department of Colorectal and Pelvic Reconstruction, Surgery, Children's National Hospital, Washington, District of Columbia, United States
| |
Collapse
|
44
|
Zheng Z, Xiao D, Wang J, Xu H, Mao J, Wang X. Case Report: Anal canal duplication associated with anorectal stenosis-A rare presentation. Front Pediatr 2022; 10:955845. [PMID: 36523396 PMCID: PMC9745053 DOI: 10.3389/fped.2022.955845] [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: 06/10/2022] [Accepted: 09/12/2022] [Indexed: 11/30/2022] Open
Abstract
Anal canal duplication is a rare gastrointestinal malformation characterized by extra anal orifices at 6 o'clock in the lithotomy position. To date, there have been only 110 reported cases. The purpose of this study is to contribute two infant cases, one of which is associated with anorectal stenosis, which has never been described.
Collapse
Affiliation(s)
- Zhen Zheng
- Department of General Surgery, Shenzhen Children's Hospital, Shenzhen, China.,College of Medicine, Shantou University, Shantou, China
| | - Dong Xiao
- Department of General Surgery, Shenzhen Children's Hospital, Shenzhen, China
| | - Junxiang Wang
- Department of General Surgery, Shenzhen Children's Hospital, Shenzhen, China
| | - Haozhong Xu
- Department of General Surgery, Shenzhen Children's Hospital, Shenzhen, China
| | - Jianxiong Mao
- Department of General Surgery, Shenzhen Children's Hospital, Shenzhen, China
| | - Xiuliang Wang
- Department of General Surgery, Shenzhen Children's Hospital, Shenzhen, China
| |
Collapse
|
45
|
Palmisani F, Krois W, Patsch J, Metzelder M, Reck-Burneo CA. High-Resolution Transperineal Ultrasound in Anorectal Malformations—Can We Replace the Distal Colostogram? European J Pediatr Surg Rep 2022; 10:e84-e88. [PMID: 35865513 PMCID: PMC9296266 DOI: 10.1055/s-0042-1750027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/02/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction
Anorectal malformations (ARM) affect 1 in 5,000 newborns with a wide range of defects. In the absence of a visible fistula, the diagnosis and classification of ARM require an augmented pressure distal colostogram. This procedure can be done after a diverting colostomy has been performed and implies exposing the child to radiation. We hypothesized that high-resolution transperineal ultrasound could correctly diagnose the type of ARM, thus sparing radiation exposure.
Case Description
Four full-term male newborns with ARM and no visible anal opening were referred to our center for further management. A diverting descendostomy was performed in the first 48 hours of life in all cases. Prior to the reconstructive surgery, we performed a high-resolution transperineal ultrasound with 3D tomographic reconstruction of the perineal region to assess the urethra, the rectum, and a possible fistula. Findings were compared with a conventional augmented pressure distal colostogram. The image acquisition was fast and did not cause any additional distress to the children.
Conclusion
In all cases the results of the distal colostogram nicely correlated with the high-resolution transperineal ultrasound with 3D tomographic reconstruction. In the future, we envision a time when it can potentially replace the distal colostogram in preoperative assessment of ARM with no distress and exposure to radiation.
Collapse
Affiliation(s)
- Francesca Palmisani
- Department of Pediatric Surgery, Medical University of Vienna, Wien, Austria
| | - Wilfried Krois
- Department of Pediatric Surgery, Medical University of Vienna, Wien, Austria
| | - Janina Patsch
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Wien, Austria
| | - Martin Metzelder
- Department of Pediatric Surgery, Medical University of Vienna, Wien, Austria
| | | |
Collapse
|
46
|
Versteegh HP, Gardner DS, Scriven L, Martens L, Kluivers K, Hewitt G, de Blaauw I, Wood RJ, Williams A, Sutcliffe J. Reconsidering Diagnosis, Treatment, and Postoperative Care in Children with Cloacal Malformations. J Pediatr Adolesc Gynecol 2021; 34:773-779. [PMID: 34419606 DOI: 10.1016/j.jpag.2021.08.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/07/2021] [Indexed: 12/25/2022]
Abstract
Cloacal malformations are among the most complex types of anorectal malformation and are characterized by the urological, genital, and intestinal tracts opening through a single common channel in the perineum. Long-term outcome is affected by multiple factors, which include anatomical variants of the malformation itself, associated anomalies, and the surgical approach. Reconsidering these variables and their influence on "patient important" function might lead to strategies that are more outcome-driven than focused on the creation of normal anatomy. Key outcomes reflect function in each of the involved tracts and the follow-up needed should therefore not only include the classical fields of colorectal surgery and urology but also focus on items such as gynecology, sexuality, family-building, and quality of life as well as other psychological aspects. Involving patients and families in determining optimal treatment strategies and outcome measures could lead to improved outcomes for the individual patient. A strategy to support delivery of personalized care for patients with cloacal malformations by aiming to define the best functional outcomes achievable for any individual, then select the treatment pathway most likely deliver that, with the minimum morbidity and cost, would be attractive. Combining the current therapies with ongoing technological advances such as tissue expansion might be a way to achieve this.
Collapse
Affiliation(s)
- Hendt P Versteegh
- Department of Pediatric Surgery, Erasmus Medical Center - Sophia Children's Hospital, Rotterdam, The Netherlands.
| | - David S Gardner
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Nottingham, United Kingdom
| | - Lucy Scriven
- School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington Campus, Nottingham, United Kingdom
| | - Lisanne Martens
- Department of Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kirsten Kluivers
- Department of Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Geri Hewitt
- Department of Pediatric and Adolescent Gynecology, Nationwide Children's Hospital, Columbus, Ohio
| | - Ivo de Blaauw
- Department of Pediatric Surgery, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Richard J Wood
- Department of Pediatric Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, Ohio
| | - Alun Williams
- Departments of Paediatric Surgery and Urology, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Jonathan Sutcliffe
- Department of Paediatric Surgery, Leeds Teaching Hospitals NHS Trust, The General Infirmary at Leeds, Leeds, United Kingdom
| | | |
Collapse
|
47
|
Arbizu R, Freiberg B, Rodriguez L. Lower Gastrointestinal Functional and Motility Disorders in Children. Pediatr Clin North Am 2021; 68:1255-1271. [PMID: 34736588 DOI: 10.1016/j.pcl.2021.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Functional and motility gastrointestinal disorders are the most common complaints to the pediatric gastroenterologist. Disorders affecting the small intestine carry a significant morbidity and mortality due to the severe limitation of therapeutic interventions available and the complications associated with such interventions. Congenital colorectal disorders are rare but also carry significant morbidity and poor quality of life plus the social stigma associated with its complications. In this review, we summarize the clinical presentation, diagnostic evaluations, and the therapeutic interventions available for the most common and severe gastrointestinal functional and motility disorders of the small bowel, colon, and anorectum.
Collapse
Affiliation(s)
- Ricardo Arbizu
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Pediatric Gastroenterology and Hepatology, Neurogastroenterology and Motility Center, Yale School of Medicine, Yale University School of Medicine, Yale New Haven Children's Hospital, 333 Cedar Street, LMP 4093, PO Box 208064, New Haven, CT 06520, USA
| | - Ben Freiberg
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Pediatric Gastroenterology and Hepatology, Neurogastroenterology and Motility Center, Yale School of Medicine, Yale University School of Medicine, Yale New Haven Children's Hospital, 333 Cedar Street, LMP 4093, PO Box 208064, New Haven, CT 06520, USA
| | - Leonel Rodriguez
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Pediatric Gastroenterology and Hepatology, Neurogastroenterology and Motility Center, Yale School of Medicine, Yale University School of Medicine, Yale New Haven Children's Hospital, 333 Cedar Street, LMP 4093, PO Box 208064, New Haven, CT 06520, USA.
| |
Collapse
|
48
|
Wu CW, Wei CC, Lin CL, Chao HH, Wei TC, Hsieh TH, Lin CY. Risk factors of vesicoureteral reflux and urinary tract infections in children with imperforate anus: A population-based case-control study in Taiwan. Medicine (Baltimore) 2021; 100:e27499. [PMID: 34871211 PMCID: PMC8568368 DOI: 10.1097/md.0000000000027499] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 09/22/2021] [Indexed: 01/05/2023] Open
Abstract
Imperforate anus (IA) is associated with several urological anomalies, including vesicoureteral reflux (VUR), a major contributor to high morbidity in patients with anorectal malformations. This retrospective study was performed to elucidate the risk factors of vesicoureteral reflux (VUR) and UTI in children with IA.We used the National Health Insurance Research Database (NHIRD) to estimate the frequency of congenital anomalies of the kidney and urinary tract (CAKUT) in children with IA. We also investigated the frequencies of VUR, UTI, and CAKUT in children with IA along with the risk factors of VUR.We enrolled 613 children between 2000 and 2008 (367 males and 246 females; 489 low-position IA and 124 high-position IA). High-position IA was associated with a significantly increased risk of VUR compared with low-position IA (OR: 2.68, 95% CI: 1.61, 4.45). In addition, children with IA along with CAKUT, hydronephrosis, or UTI had a higher risk of VUR (OR: 8.57, 95% CI: 3.75, 19.6; OR: 7.65, 95% CI: 4.48, 13.1; and OR: 31.8, 95% CI: 11.5, 88.3, respectively). UTI, as well as chromosomal anomalies, were more frequent in children with high-position IA.Patients with a high-position IA had a greater risk of VUR, particularly those with CAKUT, hydronephrosis, or UTI. Such patients must periodically undergo urinalysis to screen for UTI and early voiding cystourethrogram to rule out VUR and prevent consequent renal damage. Chromosomal analysis is suggested to rule out Down syndrome.
Collapse
Affiliation(s)
- Chung-Wei Wu
- Division of Pediatric Nephrology, Children's Hospital of China Medical University, Taichung, Taiwan
| | - Chang-Ching Wei
- Division of Pediatric Nephrology, Children's Hospital of China Medical University, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| | - Cheng-Li Lin
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
- Institute of Biostatistics, China Medical University, Taichung, Taiwan
| | - Hsiao-Huei Chao
- Division of Pediatric Surgery, Children's Hospital of China Medical University, Taichung, Taiwan
| | - Tse-Chun Wei
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Tsung-Hsueh Hsieh
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Ching-Yuang Lin
- Division of Pediatric Nephrology, Children's Hospital of China Medical University, Taichung, Taiwan
- School of Medicine, China Medical University, Taichung, Taiwan
| |
Collapse
|
49
|
Roupakias S, Sinopidis X. Pelvic Floor Muscles Contribution in Surgical Outcome of Children with High-type Anorectal Malformations. Prague Med Rep 2021; 122:191-200. [PMID: 34606431 DOI: 10.14712/23362936.2021.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
As a consequence of high-type anorectal malformations (ARMs) pathogenesis, the pelvic floor muscles remain severely underdeveloped or hypoplastic, the rectal pouch is located at the level or above the puborectalis sling, and the bowel terminates outside the sphincter muscle complex support. For children with high-type ARMs the ultimate objective of therapy is mainly to grow up having bowel continence function that is compatible with a good quality of life, and the final prognosis depends significantly on the grade of development of pelvic floor muscles and the successful entering of the anorectum fully within the support of the external anal sphincter due to intraoperative conservation of the puborectalis sling. Pelvic magnetic resonance imaging (MRI) has recently become the preferred imaging study for prediction of functional outcomes, since it can define the anatomy and evaluate the development of the sphincteric muscles before and after surgical correction. Based on recent literature and our clinical experience, we will discuss the relevance of pelvic floor muscles MRI to the clinical outcome of children with high type ARMs.
Collapse
|
50
|
One-year impact of a bowel management program in treating fecal incontinence in patients with anorectal malformations. J Pediatr Surg 2021; 56:1689-1693. [PMID: 34092385 DOI: 10.1016/j.jpedsurg.2021.04.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 04/19/2021] [Accepted: 04/27/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Many patients with anorectal malformations (ARM) need a bowel management program (BMP) to manage lifelong problems of fecal incontinence or severe constipation. We aimed to evaluate the sustainability of the results in such a program. METHODS A single-institution retrospective review was performed in children with ARM who attended our BMP (2015-2019). Standardized definitions and validated tools were used to assess fecal continence (Baylor Continence Scale), constipation (Cleveland Constipation Scoring System), urinary symptoms (Vancouver Symptoms Score), and the Pediatric Quality of Life (PedsQL) and health-related quality of life (HRQOL) at the start of BMP and 1-year after completion of the program. RESULTS 222 patients with ARM at a median age of 6.7 (IQR, 4.9-10.1) years were identified. All (100%) soiled at intake with 149 (67.1%) patients being treated with rectal or antegrade enemas and 73 (32.9%) with oral laxatives. At 1 year 150 (70.4%) were clean, 72.7% were on enemas and 27.3% were on laxatives (p = 0.08). 109 out of 148 (73.6%) patients were clean on enemas. A further 41 out of 66 (62.1%) patients were continent on laxatives with voluntary bowel movements and clean. In the group that was clean, there was improvement in Baylor Continence Scale (25 vs. 13.0, p < 0.000000002), Vancouver (11 vs. 6, p = 0.0110) scores, and clinically relevant improvement in the total PedsQL HRQL (78-85) and the PedsQL HRQL physical function (86-92) and psychosocial domain (77-82). There was no improvement in Cleveland (10 vs. 9, p = 0.31) score. CONCLUSION An intensive BMP offers significant benefits in the treatment of fecal incontinence in ARM. It appears to also improve urinary incontinence and urinary voiding as well as the patient's quality of life. These changes are sustainable over at least one year.
Collapse
|