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The treatment of high and intermediate anorectal malformations: one stage or three procedures?
Guochang Liu1, Jiyan Yuan, Jinmei Geng
1Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China.
Insights
The one-stage posterior sagittal anorectoplasty (PSARP) in neonates is a safe and feasible surgical option for high and intermediate anorectal malformations. This approach yields comparable long-term outcomes to traditional methods with fewer immediate complications.
Area of Science:
- Pediatric Surgery
- Congenital Malformations
- Surgical Outcomes
Background:
- Anorectal malformations (ARM) are complex congenital anomalies requiring surgical correction.
- Traditional repair often involves staged procedures, including colostomy.
- Evaluating novel approaches for improved outcomes is crucial.
Purpose of the Study:
- To assess the safety, feasibility, and long-term results of a complete one-stage posterior sagittal anorectoplasty (PSARP) in neonates with high and intermediate ARM.
- To compare the outcomes of one-stage PSARP with the conventional staged approach.
Main Methods:
- A retrospective study of 113 neonates with high/intermediate ARM.
- Group I (48 patients): divided colostomy, definitive operation, colostomy closure.
- Group II (65 patients): one-stage PSARP.
- Functional outcomes assessed using modified Wingspread scoring, barium enema, and anorectal manometry (ARP, ASP, PAR).
Main Results:
- One-stage PSARP (Group II) showed similar functional outcomes (Wingspread scores, anorectal angulation, barium leakage) compared to staged repair (Group I).
- Early operative complications were significantly lower in the one-stage PSARP group (29.2%) versus the staged group (56.3%).
- Colostomy-related complications were noted in 39.6% of the staged repair group.
Conclusions:
- Complete one-stage PSARP in neonates is a safe and feasible procedure for high and intermediate anorectal malformations.
- The one-stage approach offers comparable long-term functional outcomes to conventional staged repairs.
- One-stage PSARP is associated with a reduction in short-term operative complications.
Background/Purpose:
The aim of this study was to examine the safety, feasibility, and the long-term outcome of complete 1-stage repair of high and intermediate anorectal malformation using posterior sagittal anorectoplasty (PSARP) in a neonate.
Methods:
One hundred thirteen patients with high-type and intermediate-type anorectal malformations (ARM) underwent follow-up. Of 113 cases, 48 cases entailed a divided colostomy, definitive operation, and colostomy closure (group I); the other 65 patients underwent 1-stage PSARP (group II). Anorectal function was measured by the modified Wingspread scoring, including "excellent," "good," "fair," and "poor." In barium enema studies, anorectal angulation was judged as "clear," "unclear," and "not present," and leakage of barium was observed in the meantime. For anorectal manometric studies, anal resting pressure (ARP), anal squeezing pressure (ASP), and positive anorectal reflex (PAR) were measured.
Results:
In group I, the rate of excellent and good scores was 58.3% (28 of 48). In the barium enema examination, 85.4% (41 of 48) was clear and 14.6%(7 of 48) unclear or not present. The rate of barium leakage was 10.4% (5 of 48). In group II, the rate of excellent and good was 53.8% (35 of 65). Anorectal angulations were clear in 83.1% of patients (54 of 65). Barium leakage happened in 7.69% of patients (5 of 65). Early operative complications occurred in 56.3% (27 of 48) of patients in group I and 29.2% (19 of 65) in group II. The incidence of colostomy complications in group I was 39.6% (19 of 48). Soiling and constipation were the major complications after the PSARP operation. The respective rates of constipation in the 2 groups were 47.9% (23 of 48) and 44.6% (29 of 65), and the respective rates of soiling were 47.9% (23 of 48) and 50.8% (33 of 65). There was no significant difference in the mean ARP between the 2 groups.
Conclusions:
The 1-stage PSARP procedure in the neonate not only achieves the same long-term outcome as the conventional PSARP procedure but also involves fewer short-term complications. Complete 1-stage repair using the PSARP to treat high-type and intermediate-type anorectal malformations is safe and feasible.
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