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Functional outcome and quality of life in anorectal malformations
Anju Goyal1, Janice M Williams, Simon E Kenny
1Department of Paediatric Surgery, Royal Liverpool Children's Hospital NHS Trust, L12 2AP Liverpool, UK.
Insights
Children with anorectal malformations (ARMs) experience poorer bowel function, varying by lesion type. However, their quality of life remains unaffected, with no age-related decline in outcomes.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Developmental Pediatrics
Background:
- Anorectal malformations (ARMs) are congenital conditions affecting the anus and rectum.
- Early functional outcomes and quality of life (QOL) are critical for children with ARMs.
Purpose of the Study:
- To evaluate the early functional outcomes and QOL in children treated for ARMs.
- To compare functional outcomes and QOL between ARM patients and healthy controls.
Main Methods:
- A cohort of children treated for ARMs between 1994-2000, aged 4 years and above, were assessed.
- Bowel function was measured using a functional outcome questionnaire, and QOL with the Pediatric Quality of Life Inventory (PedsQL).
- Age at potty training was a secondary outcome measure, with 20 healthy children serving as controls.
Main Results:
- Eighty children with ARMs were evaluated; functional outcome scores significantly worsened with increasing ARM severity (P = .001).
- No significant difference in QOL was observed between ARM patients and controls.
- Children with ARMs required significantly more time to achieve potty training for both bladder and bowels compared to controls (P = .005 and P = .001, respectively).
Conclusions:
- Children with ARMs exhibit impaired bowel function, with severity dependent on the specific malformation.
- Despite functional deficits, overall QOL is not significantly compromised in this cohort.
- No correlation was found between patient age and functional outcome or QOL scores.
Background/Purpose:
The aim of this study was to assess the early functional outcome and quality of life (QOL) in children with anorectal malformations.
Methods:
Children treated for anorectal malformations (ARMs) from 1994 to 2000 were evaluated if 4 years or older. Primary outcome measures were bowel function score, assessed by functional outcome questionnaire, and QOL using the Pediatric Quality of Life Inventory (PedsQL 4). The secondary outcome measure was age at potty training. Twenty healthy children were used as controls for functional outcome and age at potty training. Data are reported as mean (SD) unless otherwise stated.
Results:
Eighty children were evaluated during the study period. The mean age at follow-up was 82 months (18.7). The response rate was 76.3% (58/76) for bowel function and 77.5% (62/80) for QOL questionnaires. Functional outcome score (maximum 20) decreased significantly with increasing severity of the ARM (male perineal fistula, 16 [3]; female perineal fistula, 15 [3]; rectourethral fistula, 12 [4]; vestibular fistula, 13 [3.5]; bladder neck fistula, 6 [2]; analysis of variance, P = .001). However, there was no difference in QOL between patients with ARM and controls. There was no correlation between age and either bowel function score (Pearson r2 = 0.06) or QOL (Pearson r(2) = 0.12). Affected children took significantly longer to achieve potty training for bladder (35 [13.8] months vs 26 [8.7] months for controls [t test, P = .005]) and bowels (38 [16] months vs 25 [7] months [t test, P = .001]).
Conclusion:
Children with ARMs have significantly worse bowel function than their peers, depending on the type of lesion. Despite these findings, QOL was not significantly impaired. No correlation was demonstrated between age and either functional outcome or QOL.
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