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ERN eUROGEN Guidelines on the Management of Anorectal Malformations Part III: Lifelong Follow-up and Transition of
Ophelia Aubert1, Willemijn F E Irvine2, Dalia Aminoff3
1Department of Pediatric Surgery, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.
Insights
Long-term functional problems are common after anorectal malformations (ARM) surgery. New European guidelines emphasize lifelong, patient-centered care and structured transition programs for ARM patients.
Area of Science:
- Pediatric Surgery
- Urology
- Rare Diseases
Background:
- Anorectal malformations (ARMs) are complex congenital anomalies affecting the anorectal and often genitourinary systems.
- While neonatal surgical correction is often successful, long-term functional issues are prevalent in affected children.
Purpose of the Study:
- To develop comprehensive European guidelines for the management of anorectal malformations (ARMs).
- To address challenges in long-term functional problems experienced by children with ARMs.
Main Methods:
- The Dutch Quality Standard for ARM was adapted for European application.
- Literature searches were conducted in Medline, Embase, and Cochrane databases.
- The ADAPTE method was used to integrate current evidence, with recommendations assessed by a 15-expert panel from 7 European countries.
Main Results:
- Eight new studies were identified and reviewed.
- The expert panel adapted 18, adopted 6, and developed 6 new recommendations.
- The overall level of evidence supporting the recommendations was considered low.
Conclusions:
- Lifelong follow-up and seamless transition of care are crucial for ARM patients.
- Effective management requires a dedicated multidisciplinary team of pediatric and adult specialists.
- Guidelines emphasize an individually tailored, patient-centered approach and structured transition programs.
Introduction:
Anorectal malformations (ARMs) are complex congenital anomalies of the anorectal region, oftentimes also affecting the genitourinary system. Although successful surgical correction can often be achieved in the neonatal period, many children will experience functional problems in the long term. The European Reference Network for rare and complex urogenital conditions (eUROGEN) assembled a panel of experts to address these challenges and develop comprehensive guidelines for the management of ARM.
Methods:
The Dutch Quality Standard for ARM served as the foundation for the development of guidelines applicable on a European level. Literature was searched in Medline, Embase, and Cochrane. The ADAPTE method was utilized to incorporate the newest available evidence. A panel of 15 experts from 7 European countries assessed currency, acceptability, and applicability of recommendations. Recommendations from the Dutch Quality Standard were adapted, adopted, or rejected and recommendations were formed considering the current evidence and/or expert consensus.
Results:
Lifelong follow-up, integration, and transition of care were assessed. A total of eight new studies were identified. The panel adapted 18 recommendations, adopted 6, and developed 6 de novo. Overall, the level of evidence was considered low.
Conclusion:
Successful lifelong follow-up and transition of care require a dedicated team of pediatric and adult specialist and an individually tailored patient-centered approach. This guideline summarizes the best available evidence on follow-up of ARM patients and provides guidance for the development of structured transition programs.
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