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Unexpected megarectum: A potential hidden source of complications in patients with anorectal malformation
Luis De la Torre-Mondragón1, Claudia Bañuelos-Castañeda2, Karla Santos-Jasso2
1Centro Colorrectal para Niños de México, Hospital para el Niño Poblano, Boulevard del Niño Poblano 5307 Puebla, México 72190; Colorectal Center for Children of Children's Hospital Pittsburgh of UPMC, Children's Hospital of Pittsburgh of UPMC, One Children's Hospital Drive 4401 Penn Avenue, Pittsburgh, PA 15224, USA.
Background:
Primary posterior sagittal anorectoplasty is recommended to repair anorectal malformations with rectoperineal or rectovestibular fistula. The aim of this study was to identify the impact of the presence of megarectum on the relative frequency of complications related to posterior sagittal anorectoplasty.
Methods:
We performed a cross-sectional retrospective study including patients with anorectal malformation, preoperative rectogram and surgically treated with primary or staged posterior sagittal anorectoplasty. Only complications related to anorectoplasty were analyzed and compared with the presence of megarectum.
Results:
Thirty patients aged 1 day to 7 years were included, 60% had megarectum. Sixteen patients had primary repair: 6 with megarectum and 10 without megarectum; complications occurred in four of the six with megarectum, 66.7%, and no complication were observed in the 10 patients without megarectum (F p=0.008). Fourteen patients had staged repair and no complications related to posterior sagittal anorectoplasty occurred in these patients.
Conclusions:
Comprehensive preoperative evaluation in patients with anorectal malformation with rectoperineal or rectovestibular fistula could include a rectogram. Awareness of the presence of megarectum could be useful information in the decision to create a colostomy or perform a primary posterior sagittal anorectoplasty.
Insights
Megarectum presence significantly increases complications in primary posterior sagittal anorectoplasty for anorectal malformations. Staged repair showed no complications, suggesting a safer approach for these patients.
Area of Science:
- Pediatric surgery
- Anorectal malformations
- Surgical outcomes
Background:
- Posterior sagittal anorectoplasty is standard for anorectal malformations with fistulas.
- The impact of megarectum on surgical complication rates is not well-defined.
Purpose of the Study:
- To determine if megarectum affects complication frequency after posterior sagittal anorectoplasty.
- To evaluate the role of preoperative assessment in managing these complex cases.
Main Methods:
- Retrospective cross-sectional study of patients with anorectal malformation.
- Analysis of complications related to posterior sagittal anorectoplasty, comparing patients with and without megarectum.
Main Results:
- 60% of 30 patients had megarectum.
- Primary repair in megarectum patients had a 66.7% complication rate (p=0.008), versus 0% in non-megarectum patients.
- No complications were observed in 14 patients undergoing staged repair.
Conclusions:
- Preoperative rectogram is valuable for evaluating anorectal malformations.
- Identifying megarectum can inform surgical decisions, potentially favoring colostomy over primary repair.
- Staged repair appears to be a safer alternative in cases with megarectum.
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