Short-term postoperative complications after anorectal malformation reconstruction: A 26-year experience

To assess the prevalence and severity of short-term postoperative complications (≤30 days) following anorectal malformation (ARM) reconstruction, and explore potential risk factors for minor and major complications.

This retrospective cohort study included all ARM patients born between January 2000 and December 2025 who underwent definitive reconstruction. Short-term postoperative complications were classified according to the Clavien-Madadi classification. Univariable and multivariable logistic regression analyses were performed.

278 patients were included, of whom 49.6% were female. Median age (IQR) at reconstruction was 4 months (3-6). Short-term postoperative complications occurred in 78 patients (28.1%), including 53 (19.1%) minor and 25 (9.0%) major complications. Wound dehiscence occurred most frequently (n = 57; 20.5%). In multivariable analysis, surgical techniques other than ASARP or PSARP were associated with lower odds of minor complications (OR 0.14, 95% CI 0.03-0.62). Major complications were associated with VACTERL association (OR 6.27, 95% CI 2.43-16.22) and inversely with pre-reconstructive colostomy creation (OR 0.26, 95% CI 0.08-0.82).

Of all patients, 28.1% experienced short-term postoperative complications after ARM reconstruction. Minor complications were associated with type of surgery, whereas major complications were associated with VACTERL association and inversely with pre-reconstructive colostomy creation.