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Published on: January 7, 2019
Long-Term Functional Outcomes of an Anorectal Malformation French National Cohort
Françoise Schmitt1, Aurélien Scalabre2, Pierre Yves Mure3
1Pediatric Surgery Department, University Hospital, Angers.
Insights
Long-term outcomes for anorectal malformations (ARMs) show that rectal pouch level impacts bowel function. Age improves some outcomes, but supportive care remains crucial for all patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Developmental Biology
Background:
- Anorectal malformations (ARMs) are congenital conditions requiring surgical correction.
- Assessing long-term functional outcomes is vital for patient management and quality of life.
Purpose of the Study:
- To evaluate the long-term functional results in children treated for ARM.
- To identify factors influencing functional outcomes in different age groups.
Main Methods:
- Retrospective cross-sectional study of 367 patients (ages 6-30 years) surgically treated for ARM.
- Analysis of patient and ARM characteristics, including level and surgical approach.
- Statistical analysis using logistic regression to determine outcome correlations.
Main Results:
- Rectal blind pouch level correlated significantly with voluntary bowel movements, soiling, stool/gas discrimination, and constipation.
- Risk factors for constipation included sacral abnormalities and non-abdominal surgical approaches.
- Improvements with age were observed in voluntary bowel movement control and soiling rates.
Conclusions:
- A strong association exists between anatomical status and functional outcomes in surgically treated ARM patients.
- Long-term follow-up and supportive care are essential for all individuals with ARM.
- Understanding these associations aids in personalized patient management and prognosis.
Objectives:
The present study aimed to assess long-term functional outcomes of children with anorectal malformations (ARMs) across a network of expert centers in France.
Methods:
Retrospective cross-sectional study of patients ages 6-30 years that had been surgically treated for ARM. Patient and ARM characteristics (eg, level, surgical approach) and functional outcomes were assessed in the different age groups.
Results:
Among 367 patients, there were 155 females (42.2%) and 212 males (57.8%), 188 (51.2%) cases with, and 179 (48.8%) higher forms without, perineal fistula. Univariate and multivariate statistical analyses with logistic regression showed correlation between the level of the rectal blind pouch and voluntary bowel movements (odds ratio [OR] = 1.84 [1.31-2.57], P < 0.001), or soiling (OR = 1.72 [1.31-2.25], P < 0.001), which was also associated with the inability to discriminate between stool and gas (OR = 2.45 [1.28-4.67], P = 0.007) and the presence of constipation (OR = 2.97 [1.74-5.08], P < 0.001). Risk factors for constipation were sacral abnormalities [OR = 2.26 [1.23-4.25], P = 0.01) and surgical procedures without an abdominal approach (OR = 2.98 [1.29-6.87], P = 0.01). Only the holding of voluntary bowel movements and soiling rates improved with age.
Conclusion:
This cross-sectional study confirms a strong association between anatomical status and functional outcomes in patients surgically treated for ARM. It specifically highlights the need for long-term follow-up of all patients to help them with supportive care.
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