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Wound Dehiscence after Posterior Sagittal Anorectoplasty in Children with Anorectal Malformations
Louise Tofft1, Martin Salö1, Einar Arnbjörnsson1
1Department of Paediatric Surgery, Skåne University Hospital, Department of Clinical Sciences, Paediatrics, Lund University, Lund, Sweden.
Insights
A colostomy significantly reduced wound dehiscence after posterior sagittal anorectoplasty (PSARP) in children with anorectal malformations (ARM). No specific risk factors were found for wound dehiscence in single-stage PSARP procedures.
Area of Science:
- Pediatric Surgery
- Congenital Malformations
- Surgical Outcomes
Background:
- Anorectal malformations (ARM) are complex congenital anomalies requiring surgical correction.
- Posterior sagittal anorectoplasty (PSARP) is a common surgical technique for ARM.
- Wound dehiscence is a potential postoperative complication following PSARP.
Purpose of the Study:
- To determine the incidence of wound dehiscence after PSARP in pediatric patients.
- To identify factors contributing to wound dehiscence after PSARP.
- To evaluate the protective effect of a colostomy on wound healing post-PSARP.
Main Methods:
- Retrospective review of 90 pediatric patients undergoing PSARP between 2001 and 2016.
- Analysis of wound dehiscence within 30 days postoperatively.
- Multiple regression analysis to identify risk factors in single-stage PSARP.
Main Results:
- Wound dehiscence occurred in 43% of patients without a colostomy versus 22% with a colostomy (p=0.043).
- No specific risk factors (e.g., cardiac malformations, low weight, antibiotic duration, fasting period) were identified for wound dehiscence in single-stage PSARP.
- Ninety patients were analyzed, with 59% being male.
Conclusions:
- A divided colostomy appears to protect against wound dehiscence following PSARP.
- No identifiable risk factors for wound dehiscence were found in single-stage PSARP.
- Further research is necessary to elucidate factors promoting uncomplicated wound healing after PSARP.
Aim Of The Study:
To assess the frequency of and identify contributing factors to wound dehiscence after posterior sagittal anorectoplasty (PSARP) in children born with anorectal malformations (ARM).
Methods:
Ethical approval was obtained (DNR 2017/191). Charts of all children with anorectal malformations (ARM) reconstructed with PSARP, limited PSARP, or PSARVUP at a tertiary centre of paediatric surgery between 2001 and 2016 were reviewed. Wound dehiscence within 30 days postoperatively was analysed regarding gender, prematurity, birth weight, type of ARM, other congenital malformations, single- or multistaged reconstruction, age and weight at reconstruction, postoperative antibiotics, and fasting. Multiple regression analysis was performed for risk factors in single-stage PSARP or limited PSARP, presented as odds ratio (OR) with 95% confidence interval (CI).
Main Results:
Ninety patients were included, of which 53 (59%) were males. Single-staged PSARP was performed in 40 (44%) patients and 50 (56%) had a multistaged reconstruction with a colostomy. Wound dehiscence was significantly more common among patients without a colostomy; 17 (43%) vs. 11 (22%) (p=0.043). In patients with single-stage PSARP, no single factor was identified to increase the risk for wound dehiscence: cardiac malformations (OR 3.73) (95% CI 0.78-17.88), low weight at surgery (OR 1.56) (95% CI 0.36-6.99), antibiotics < 1 day (OR 1.6) (95% CI 0.43-5.94), or short fasting 0-3 days (OR 4.44) (95% CI 0.47-42.18).
Conclusions:
A divided colostomy protected against wound dehiscence after PSARP. No risk factor for wound dehiscence after single-staged PSARP was identified. Further studies are needed to establish contributing factors to uncomplicated wound healing after PSARP.
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