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Can fecal continence be predicted in patients born with anorectal malformations?

Peter C Minneci1, Rashmi S Kabre2, Grace Z Mak3

  • 1Department of Pediatric Surgery and the Research Institute, Nationwide Children's Hospital, Columbus, OH.

Journal of Pediatric Surgery
|March 23, 2019
PubMed

Insights

Anorectal malformations (ARM) subtypes, not spinal anomalies, predict fecal continence in children. Even mild ARM types show high incontinence rates, necessitating long-term management.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Developmental Biology

Background:

  • Anorectal malformations (ARM) represent a spectrum of congenital anomalies affecting the terminal part of the gastrointestinal tract.
  • Achieving fecal continence is a significant challenge for children with ARM, impacting their quality of life.
  • Predicting the likelihood of fecal continence at birth remains difficult due to the complexity of ARM and associated factors.

Purpose of the Study:

  • To identify predictive factors for achieving fecal continence in children diagnosed with anorectal malformations (ARM).
  • To analyze the association between birth-related factors, including ARM subtype and spinal/sacral imaging, and long-term fecal continence outcomes.

Main Methods:

  • A multi-institutional prospective cohort study involving children born with ARM between 2007-2011.
  • Fecal continence was assessed using the Baylor Social Continence Scale in children aged 4 years or older.
  • Multivariable logistic regression was employed to identify predictors of continence based on factors present at birth.

Main Results:

  • Of 144 ARM patients (median age 7 years), 58 (40%) achieved fecal continence.
  • Continence rates varied significantly by ARM subtype (p = 0.002), with the highest rate (60%) observed in patients with a perineal fistula.
  • Less severe ARM subtypes (e.g., perineal fistula, recto-vestibular fistula) were strongly associated with higher odds of continence (OR = 7.4, p = 0.001).
  • Spinal anomalies and the lateral sacral ratio did not show a significant association with fecal continence.

Conclusions:

  • The specific subtype of anorectal malformation (ARM) is the primary predictor of fecal continence in affected children.
  • The substantial rates of incontinence, even in less severe ARM subtypes, underscore the difficulty in predicting continence at birth.
  • Long-term follow-up and dedicated bowel management programs are crucial for children with ARM to optimize continence outcomes.
Abstract

Keywords:
Anorectal malformationContinencePredictorsSacral ratioSpine

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