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Patient-reported Outcomes of Children With an Anorectal Malformation
Richard J Wood1, Shruthi Srinivas1, Misel Trajanovska2,3,4
1Department of Colorectal and Pelvic Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH.
Insights
Anorectal malformation type, not sacral ratio, impacts continence in children. Continence improves with age, but enema use with soiling negatively affects quality of life.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Urology
Background:
- Anorectal malformation (ARM) is associated with lifelong dysfunctional stooling.
- Factors influencing continence and quality of life (QoL) in pediatric ARM patients remain unclear.
- Understanding these factors is crucial for improving long-term outcomes.
Purpose of the Study:
- To investigate the impact of ARM type and sacral ratio on continence.
- To compare continence outcomes across different age groups.
- To assess QoL in relation to various bowel management strategies.
Main Methods:
- A cohort of 910 children (aged 2-19) with ARM completed validated surveys on stooling and QoL.
- Sacral ratio was used to classify sacral hypodevelopment (normal, moderate, severe).
- Continence was defined as voluntary bowel movements; patients were compared based on enema use and other bowel regimens.
Main Results:
- Continence rates improved significantly with age (50% in ≤6 years, 69.8% in 6-12 years, 82.1% in >12 years).
- ARM type, not sacral ratio, was associated with continence in patients managed with laxatives.
- Patients on enemas experiencing soiling reported significantly lower QoL compared to those on laxatives or clean on enemas.
Conclusions:
- ARM type is a significant factor for continence, whereas sacral ratio is not, in children managed with laxatives.
- Age is positively correlated with improved continence in pediatric ARM patients.
- Aggressive bowel management with enemas, when associated with soiling, detrimentally impacts QoL.
Objective:
We aimed to study the impact of anorectal malformation (ARM) type and sacral ratio on continence outcomes in children. We secondarily aimed to compare continence outcomes by age group and determine quality of life (QoL) with different bowel regimens.
Summary Background Data:
Children with ARM experience dysfunctional stooling into adulthood. Little is known about how ARM type, sacral ratio, age, and bowel regimen affect continence and QoL.
Methods:
We administered validated assessments of stooling habits and QoL to children aged 2-19 years with ARM at 2 tertiary hospitals. Sacral ratio as a determinant of sacral hypodevelopment was defined as normal (≥0.7), moderate (0.4-0.0.69), or severe (≤0.39). Children not on an enema program were compared with those on an enema program to identify factors associated with achieving voluntary bowel movements, defined as continence. All children were compared with identify factors associated with QoL.
Results:
Of 910 patients, half (52.8%) had mild sacral hypodevelopment. In patients not receiving enemas managed solely at study hospitals, most were continent (69.2%). There were no differences in continence demonstrated by sacral ratio; 79.4% of those who were continent had normal/moderate sacral hypodevelopment and mild ARM.Continence improved with age (50% ≤6 y old, 69.8% 6-12 y old, 82.1% >12 y old; P <0.001). Those on enemas and soiling had a QoL 19.6 points lower than those soiling on laxatives, and 20.7 points lower than those who were clean on enemas or continent with voluntary bowel movements without the need for enemas.
Conclusions:
In patients on laxatives, the type of malformation, but not sacral ratio, is associated with continence in patients with ARM. Continence improves with age; those on enemas with soiling have a worse QoL.
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