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Sacral Spina Bifida Occulta: A Frequency Analysis of Secular Change. ANTHROPOLOGICAL REVIEW 2022. [DOI: 10.18778/1898-6773.85.2.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Substantial relaxation of natural selection beginning around 1900 changed the mutation/selection balance of modern genetic material, producing an increase in variable anatomical structures. While multiple structures have been affected, the temporal increase in variations of the sacrum, specifically, ‘Sacral Spina Bifida Occulta,’ have been reliably demonstrated on a localised scale. Calculation of largescale frequency has been hindered by the localised nature of these publications, the morphological variability of this variation, and potential pathological associations, which have produced divergent classifications, and conflicting reported rates of occurrence. A systematic review of the reported literature was conducted to provide an objective analysis of Sacral Spina Bifida Occulta frequency from 2500 BCE to the present. This review was designed to compensate for observed inconsistencies in reporting and to ascertain, for the first time, the temporal trajectory of this secular trend. A systematic review of Sacral Spina Bifida Occulta literature was conducted through the strict use of clinical meta-analysis criteria. Publications were retrieved from four databases: PubMed, Embase, the Adelaide University Library database, and Google Scholar. Data were separated into three historical groups, (1 = <1900, 2 = 1900 to 1980 and 3 = >1980), and frequency outcomes compared, to determine temporal rates of occurrence.
A total of 39/409 publications were included in the final analysis, representing data for 16,167 sacra, spanning a period of 4,500 years. Statistically significant results were obtained, with total open S1 frequency increasing from 2.34%, (79 to 1900CE), to 4.80%, (1900 to 1980CE) and to 5.43% (>1980CE). These increases were significant at p<0.0001, with Chi-squared analysis. A clear secular increase in the global frequency of Sacral Spina Bifida Occulta has been demonstrated from 1900 to the present. This research provides a novel and adaptable framework for the future assessment of variation distribution, with important implications for the fields of biological anthropology and bioarchaeology.
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Küppers J, van Eckert V, Muensterer NR, Holler AS, Rohleder S, Kawano T, Gödeke J, Muensterer OJ. Percutaneous Anorectoplasty (PARP)—An Adaptable, Minimal-Invasive Technique for Anorectal Malformation Repair. CHILDREN 2022; 9:children9050587. [PMID: 35626764 PMCID: PMC9140123 DOI: 10.3390/children9050587] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 12/18/2022]
Abstract
Background: Anorectal malformations comprise a broad spectrum of disease. We developed a percutaneous anorectoplasty (PARP) technique as a minimal-invasive option for repair of amenable types of lesions. Methods: Patients who underwent PARP at five institutions from 2008 through 2021 were retrospectively analyzed. Demographic information, details of the operative procedure, and perioperative complications and outcomes were collected. Results: A total of 10 patients underwent the PARP procedure during the study interval. Patients either had low perineal malformations or no appreciable fistula. Most procedures were guided by ultrasound, fluoroscopy, or endoscopy. Median age at PARP was 3 days (range 1 to 311) days; eight patients were male. Only one intraoperative complication occurred, prompting conversion to posterior sagittal anorectoplasty. Functional outcomes in most children were highly satisfactory in terms of continence and functionality. Conclusions: The PARP technique is an excellent minimal-invasive alternative for boys born with perineal fistulae, as well as patients of both sexes without fistulae. The optimal type of guidance (ultrasound, fluoroscopy, or endoscopy) depends on the anatomy of the lesion and the presence of a colostomy at the time of repair.
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Affiliation(s)
- Julia Küppers
- Department of Pediatric Surgery, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University Medical Center, 80337 Munich, Germany; (J.K.); (V.v.E.); (N.R.M.); (A.-S.H.); (J.G.)
| | - Viviane van Eckert
- Department of Pediatric Surgery, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University Medical Center, 80337 Munich, Germany; (J.K.); (V.v.E.); (N.R.M.); (A.-S.H.); (J.G.)
| | - Nadine R. Muensterer
- Department of Pediatric Surgery, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University Medical Center, 80337 Munich, Germany; (J.K.); (V.v.E.); (N.R.M.); (A.-S.H.); (J.G.)
| | - Anne-Sophie Holler
- Department of Pediatric Surgery, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University Medical Center, 80337 Munich, Germany; (J.K.); (V.v.E.); (N.R.M.); (A.-S.H.); (J.G.)
| | - Stephan Rohleder
- Department of Pediatric Surgery, Johannes-Gutenberg-University Medical Center Mainz, 55131 Mainz, Germany;
| | - Takafumi Kawano
- Department of Pediatric Surgery, Kagoshima University, Kagoshima 890-8520, Japan;
| | - Jan Gödeke
- Department of Pediatric Surgery, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University Medical Center, 80337 Munich, Germany; (J.K.); (V.v.E.); (N.R.M.); (A.-S.H.); (J.G.)
| | - Oliver J. Muensterer
- Department of Pediatric Surgery, Dr. von Hauner Children’s Hospital, Ludwig-Maximilians-University Medical Center, 80337 Munich, Germany; (J.K.); (V.v.E.); (N.R.M.); (A.-S.H.); (J.G.)
- Correspondence: ; Tel.: +49-894-4005-3101
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Lacher M, Badillo A, Vilanova-Sánchez A, Rentea RM, Gosemann JH, Levitt MA. Laparoscopic Approach in Anorectal Malformations: How We Do It. J Laparoendosc Adv Surg Tech A 2021; 31:1200-1208. [PMID: 34551270 DOI: 10.1089/lap.2021.0422] [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: 11/13/2022] Open
Abstract
Laparoscopy has a major role in the treatment of anorectal malformations (ARM) since Georgeson et al. introduced the laparoscopic assisted anorectoplasty in 2000. The majority of ARM can be repaired through a posterior sagittal incision without the need to enter the abdomen. Some ARM types require an abdominal approach to detach the rectum from the urinary tract in males or the vagina in females. Those malformations benefit from laparoscopy. In this article, we aimed to highlight the technical aspects relevant to the current laparoscopic repair of ARM.
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Affiliation(s)
- Martin Lacher
- Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany
| | - Andrea Badillo
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, USA
| | - Alejandra Vilanova-Sánchez
- Urogenital and Colorectal Unit, Department of Pediatric Surgery, University Hospital La Paz, Madrid, Spain
| | - Rebecca M Rentea
- Department of Pediatric Surgery, Comprehensive Colorectal Center, Children's Mercy Hospital, Kansas City, Missouri, USA
| | | | - Marc A Levitt
- Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, District of Columbia, USA
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Ishimaru T, Kawashima H, Hayashi K, Omata K, Sanmoto Y, Inoue M. Laparoscopically assisted anorectoplasty-Surgical procedures and outcomes: A literature review. Asian J Endosc Surg 2021; 14:335-345. [PMID: 33029900 DOI: 10.1111/ases.12877] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/08/2020] [Accepted: 09/22/2020] [Indexed: 11/27/2022]
Abstract
Anorectal malformation includes various types of anomalies. The goal of definitive surgery is achievement of fecal continence. Twenty years have passed since laparoscopically assisted anorectoplasty (LAARP) was reported by Georgeson. Since LAARP is gaining popularity, its long-term outcomes should be evaluated. Presently, there is no evidence regarding the optimal method of ligating and dividing the fistula correctly and creating the pull-through canal accurately. Rectal prolapse and remnant of the original fistula (ROOF) tend to develop more often in LAARP patients than in posterior sagittal anorectoplasty (PSARP) patients; however, robust evidence is not available. Prolapse may be prevented by suture fixation of the rectum to the presacral fascia; however, if prolapse occurs, the indication, timing, and the best method for surgical correction remain unclear. Most patients with ROOF are asymptomatic, and there is controversy regarding the indications for ROOF resection. This article aimed to detail the various modifications of the LAARP procedures reported previously and to describe the surgical outcomes, particularly focusing on rectal prolapse, ROOF, and fecal continence, by reviewing the literature. Functional outcomes after LAARP were almost similar to those noted after PSARP, and we have demonstrated that LAARP is not inferior to PSARP with respect to fecal continence. Although there is controversy regarding the application of LAARP for recto-bulbar cases, we believe that LAARP is still evolving, and we can achieve better outcomes by improving the procedure.
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Affiliation(s)
- Tetsuya Ishimaru
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Hiroshi Kawashima
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Kentaro Hayashi
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Kanako Omata
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Yohei Sanmoto
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
| | - Maho Inoue
- Division of Pediatric Surgery, Saitama Children's Medical Center, Saitama, Japan
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Rentea RM, Badillo AT, Hosie S, Sutcliffe JR, Dickie B. Lasting impact on children with an anorectal malformations with proper surgical preparation, respect for anatomic principles, and precise surgical management. Semin Pediatr Surg 2020; 29:150986. [PMID: 33288132 DOI: 10.1016/j.sempedsurg.2020.150986] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Optimal outcomes in the management of children with Anorectal Malformation (ARM) require careful surgical preparation and detailed understanding of the anatomic principles and operative setup. A clear understanding of operative anatomy and surgical principals guides decision making. Adherence to the principles of ARM repair, as well as the application of operative and imaging adjuncts, will yield the safest and most successful approach to ARM. In this review, we detail the surgical preparation, anatomic principles, and surgical management issues unique to ARM.
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Affiliation(s)
- Rebecca M Rentea
- Comprehensive Colorectal Center, Department of Surgery, Children's Mercy-Kansas City, Kansas City, MO 64108, USA.
| | - Andrea T Badillo
- Divisions of Pediatric Surgery and Colorectal and Pelvic Reconstruction, Children's National Hospital, Washington, DC, USA
| | - Stuart Hosie
- Department of Pediatric Surgery, Stadtisches Kinikum Munchen GmBH, Munich, Germany
| | - Jonathan R Sutcliffe
- Department of Pediatric Surgery, Leeds General Infirmary, Leeds LS1 3EX, United Kingdom
| | - Belinda Dickie
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
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Apte A, Brisighelli G, McKenna E, Levitt MA. Image of the Month: High Pressure Distal Colostogram in a Patient with an Anorectal Malformation. European J Pediatr Surg Rep 2020; 8:e108-e111. [PMID: 33244451 PMCID: PMC7684984 DOI: 10.1055/s-0040-1721051] [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: 05/29/2020] [Accepted: 08/18/2020] [Indexed: 11/24/2022] Open
Abstract
An adequately performed high pressure distal colostogram is crucial to plan surgery in male patients born with anorectal malformations. We present two male patients that underwent a divided sigmoid colostomy with distal mucus fistula in the neonatal period and at 6 months of age underwent a high pressure distal colostogram. In the discussion, we will give some tricks beyond the known rules: how to correctly interpret a high pressure distal colostogram, how to identify the level of a recto-urinary fistula, and how to accurately plan the surgical approach.
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Affiliation(s)
- Anisha Apte
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, United States
| | - Giulia Brisighelli
- Department of Surgery, Paediatric Surgery, Chris Hani Baragwanath Hospital, Johannesburg, Gauteng, South Africa
| | - Elise McKenna
- Department of General and Thoracic Surgery, Children's National Medical Center, Washington, District of Columbia, United States
| | - Marc A Levitt
- Department of Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, United States.,Department of General and Thoracic Surgery, Children's National Medical Center, Washington, District of Columbia, United States.,Division of Colorectal and Pelvic Reconstruction Surgery, Children's National Medical Center, Washington, District of Columbia, United States
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