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Published on: June 13, 2025
Single-stage versus staged reconstruction for high and intermediate anorectal malformations in neonates: a systematic
Tuyen Tran1, Chuong Ngoc Thi Dang2, Chieu Minh Vuong3
1Department of Pediatrics, Vinmec Central Park, Vinmec International Hospital, Ho Chi Minh City, Vietnam. tuyen.tran97@gmail.com.
Insights
This review found no significant difference in bowel continence outcomes between single-stage and staged surgical repair for anorectal malformations. More high-quality studies are needed to confirm findings and assess infection risks.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Research Methodology
Background:
- Surgical management for high and intermediate anorectal malformations (ARMs) lacks a consensus approach.
- Continence and infection rates are key outcome measures influencing surgical decision-making.
Purpose of the Study:
- To systematically review and compare continence and infection outcomes between single-stage and staged surgical repair for neonates with high or intermediate ARMs.
Main Methods:
- Systematic review and random-effects meta-analysis of four comparative studies (746 patients).
- Searches of MEDLINE, Embase, and Cochrane CENTRAL databases.
- Risk of bias assessed using ROBINS-I; GRADE certainty evaluated.
Main Results:
- No significant difference in incontinence outcomes between single-stage and staged repair (RR 0.93, p=0.80) with substantial heterogeneity (I²=83%).
- Infection data could not be pooled due to reporting issues.
- All studies had moderate to serious risk of bias; GRADE certainty was LOW for incontinence and VERY LOW for infection.
Conclusions:
- Current evidence, with LOW certainty, does not support the superiority of either surgical approach for bowel continence in ARMs.
- Insufficient evidence (VERY LOW certainty) exists to compare infection outcomes.
- Substantial uncertainty necessitates prospective studies with standardized outcomes.
Abstract:
The surgical approach to high and intermediate anorectal malformations remains controversial. This systematic review compared continence and infection outcomes between the two approaches. MEDLINE, Embase, and Cochrane CENTRAL were searched per a registered protocol (PROSPERO CRD420261291319). Comparative studies of single-stage versus staged repair in neonates with high or intermediate anorectal malformations were included. Risk of bias was assessed using ROBINS-I. Random-effects meta-analysis with prediction intervals was performed. Four comparative studies (746 patients: 399 single-stage, 347 staged) were included. Pooled analysis showed no significant difference in incontinence outcomes (RR 0.93, 95% CI: 0.52-1.66, p = 0.80; 95% prediction interval: 0.28-3.08) with substantial heterogeneity (I²=83%). Infection data could not be pooled due to methodological concerns in outcome reporting. All included studies demonstrated moderate to serious risk of bias. GRADE certainty was LOW for incontinence and VERY LOW for infection. Current evidence does not demonstrate superiority of either approach for bowel continence (LOW certainty). Infection evidence was insufficient for synthesis (VERY LOW). Wide prediction intervals indicate substantial uncertainty; available data cannot confirm or refute inferior outcomes after single-stage repair. Prospective studies with standardized outcomes are needed. Protocol registration: PROSPERO CRD420261291319.
