Congenital pouch colon: A comparative study between two modalities of management

Area of Science:

• Pediatric Surgery
• Congenital Anomalies
• Gastrointestinal Surgery

Background:

• Congenital pouch colon (CPC) is a rare gastrointestinal anomaly with a distinct geographical prevalence.
• Anorectal malformations (ARM) represent a spectrum of congenital defects requiring surgical intervention.

Purpose of the Study:

• To determine the incidence of CPC within a cohort of ARM cases at a single institution.
• To compare the clinical outcomes of a two-staged surgical approach versus a conventional three-staged approach for CPC management.

Main Methods:

• A retrospective analysis of 754 ARM cases over a 7-year period (April 2013 - March 2020).
• Identification and classification of CPC cases, including preoperative diagnosis rates and intraoperative findings (e.g., Type IV variety).
• Comparison of survival rates and final clinical outcomes between patients managed with three-stage and two-stage surgical protocols.

Main Results:

• Forty-three cases of CPC were identified among 754 ARM patients, yielding an incidence of 7.6% in high ARM cases.
• CPC demonstrated a male predominance (M:F ratio of 4.4:1) and was preoperatively diagnosed in 72% of cases.
• Initial survival rates were 82% for the three-stage and 88% for the two-stage approach. Final outcomes favored the two-stage method (54% vs. 47%).

Conclusions:

• Congenital pouch colon, while rare, represents a significant subset (7.6%) of high ARM cases.
• The two-staged surgical management approach for CPC is associated with improved survival and reduced morbidity compared to the conventional three-staged surgery.
• This study supports the adoption of a two-stage protocol for better patient outcomes in congenital pouch colon cases.