Outcome after vacuum-assisted closure in patients with anorectal malformations-a multi-center comparative study

In patients with anorectal malformations (ARM), perineal wound complications following posterior sagittal anorectoplasty (PSARP) remain a challenge with an occurrence of 22%-43%. In adults, vacuum-assisted closure (VAC) aims to support wound healing after colorectal procedures. In children evidence is limited, suggesting a potential benefit of VAC therapy after PSARP. We aimed to evaluate the impact of VAC therapy on outcomes after PSARP in a multicenter comparative study.

All consecutive patients who underwent PSARP from 01/2018-12/2025 in two participating pediatric surgical departments were included. Complications including postoperative perineal wound dehiscence were analyzed. The study was approved by the local ethics committee (approval number: 12354-BO-K-2026).

48 patients were included: 26 with and 22 without VAC therapy. Baseline characteristics, follow-up duration and the interval until first follow-up were comparable between cohorts respectively. Postoperative outcomes did not differ significantly between groups. Stool smearing occurred in none of the patients in the VAC cohort and in one patient in the non-VAC cohort (p > 0.99). No incontinence was observed in either cohort (p > 0.99). Perineal wound dehiscence occurred in two patients (8%) in the VAC and in one (5%) in the non-VAC cohort (p > 0.99).

In our study, VAC therapy was associated with comparable rates of postoperative wound dehiscence after PSARP compared to the non-VAC cohort and to previous reports. Larger, prospective studies are required to confirm our findings.