Results of surgical treatment of anorectal malformations in children
DOI:
https://doi.org/10.15574/PS.2025.4(89).8392Keywords:
anorectal malformations, surgical treatment, prevention, complications, functional results, anal incontinence, newbornsAbstract
The problem of treating anorectal malformations (ARM) in children remains relevant, which is due to their high frequency, combination with other developmental defects, and a significant number of functional disorders that occur in operated children.
Aim - to study the immediate and long-term results of treatment of children with ARM and improve the correction of postoperative complications.
Materials and methods. Examination and treatment of 37 children operated on for ARM, 18 boys and 19 girls, were conducted. In addition to general clinical examination methods, anoscopy and rectoscopy were performed in operated children, examination using a myotester, and transanal ultrasound. The severity of fecal incontinence (FI) was determined by the Cleveland scale. The study of quality of life (QoL) in operated children was carried out by questionnaire.
Results. Early postoperative complications after various stages of treatment, requiring reoperation, occurred in 5 children (13.51%). Good functional results of ARM correction were in 23 patients (62.16%); satisfactory in 13 children (35.14%) and unsatisfactory in one child (2.7%). The most common long-term functional disorders in operated children in the long-term period were FI of various degrees (from minor fecal smearing to significant fecal incontinence), which was detected in 14 patients (37.84%) and constipation (9 children, 24.32%). These patients received a complex of treatment, which included a bowel management program and minimally invasive surgical correction of anal sphincter insufficiency using a bulk-forming gel.
Conclusions. The total frequency of early postoperative complications in children operated on for ARM was 13.51%. Remote functional disorders of the colon and rectum of varying severity occurred in 62.16% of patients. The most frequent remote functional disorders in operated children were FI and postoperative constipation. The use of a complex of treatment and prevention of these disorders led to a significant improvement in defecation control and QoL of patients.
The study was conducted in accordance with the Declaration of Helsinki. The protocol was approved by the local ethics committee. Written informed consent was obtained from the children’s legal guardians.
The authors declare no conflict of interest.
References
Bischoff A, Levitt M, Pena A. (2009). Bowel management for the treatment of pediatric fecal incontinence. Pediatr. Surg. Int. 25; 12: 1027-1042. https://doi.org/10.1007/s00383-009-2502-z; PMid:19830436 PMCid:PMC2777229
Bischoff A, Tovilla M. (2010). A practical approach to the management of pediatric fecal incontinence. Seminars in Pediatric Surgery. 19(2): 154-159. https://doi.org/10.1053/j.sempedsurg.2009.11.020; PMid:20307852
Cassina M, Fascetti Leon F, Ruol M, Chiarenza SF, Scirè G et al. (2019). Prevalence and survival of patients with anorectal malformations: A population-based study. J. Pediatr. Surg. 54(10): 1998-2003. https://doi.org/10.1016/j.jpedsurg.2019.03.004; PMid:30935729
Dewberry L, Trecartin A, Peña A, St. Pierre M, Bischoff A. (2019). Systematic review: sacral nerve stimulation in the treatment of constipation and fecal incontinence in children with emphasis in anorectal malformation. Pediatric Surgery International. 35(9): 1009-1012. https://doi.org/10.1007/s00383-019-04515-z; PMid:31256299
Divarci E, Ergun O. (2020, Apr). General complications after surgery for anorectal malformations. Pediatr Surg Int. 36(4): 431-445. Epub 2020 Feb 21. https://doi.org/10.1007/s00383-020-04629-9; PMid:32086570
Fernandez-Portilla E, Moreno-Acosta L, Dominguez-Muñoz A et al. (2021). Functional outcome after cord detethering in fecally incontinent patients with anorectal malformations. Pediatr. Surg. Int. 37: 419-424. https://doi.org/10.1007/s00383-020-04834-6; PMid:33427923
Fofanov VO, Fofanov ОD, Jurtseva AP, Volosyanko AB, Diduh IM. (2022). Quality of children's life after surgical correction of congenital colorectal pathology. Paediatric Surgery (Ukraine). 3(76): 74-85. https://doi.org/10.15574/PS.2022.76.74
Hanneman MJ, Sprangers MA, De Mik EL, Ernest van Heurn LW, De Langen ZJ, Looyaard N et al. (2001). Quality of life in patients with anorectal malformation or Hirschsprung's disease: development of a disease-specific questionnaire. Dis. Colon Rectum. 44(11): 1650-1660. https://doi.org/10.1007/BF02234386; PMid:11711738 PMCid:PMC12851377
Hartman EE, Oort FJ, Aronson DC, Sprangers MA. (2011). Quality of life and disease-specific functioning of patients with anorectal malformations or Hirschsprung's disease: a review. Arch. Dis. Child. 96(4): 398-406. https://doi.org/10.1136/adc.2007.118133; PMid:20371581
Holbrook C, Misra D, Zaparackaite I, Cleeve S. (2017, Aug). Post-operative strictures in anorectal malformation: trends over 15 years. Pediatr Surg Int. 33(8): 869-873. Epub 2017 Jun 14. https://doi.org/10.1007/s00383-017-4111-6; PMid:28616723
Holcomb GW III, Murphy JP, St. Peter SD. (2020). Holcomb and Ashcraft's Pediatric Surgery, 7th edition. Elsevier: 1291.
Huang CF, Lee HC, Yeung CY, Chan WT, Jiang CB, Sheu JC et al. (2012, Aug). Constipation is a major complication after posterior sagittal anorectoplasty for anorectal malformations in children. Pediatr Neonatol. 53(4): 252-256. Epub 2012 Jul 28. https://doi.org/10.1016/j.pedneo.2012.06.007; PMid:22964283
Jumbi T, Kuria K, Osawa F, Shahbal S. (2019). The effectiveness of digital anal dilatation in preventing anal strictures after anorectal malformation repair. J. Pediatr. Surg. 54(10): 2178-2181. https://doi.org/10.1016/j.jpedsurg.2019.04.004; PMid:31053362
Kyrklund K, Neuvonen MI, Pakarinen MP, Rintala R.J. (2018). Social Morbidity in Relation to Bowel Functional Outcomes and Quality of Life in Anorectal Malformations and Hirschsprung's Disease. Eur. J. Pediatr. Surg. 28(06): 522-528. https://doi.org/10.1055/s-0037-1607356; PMid:29059696
Levitt MA, Peña A. (2005) Outcomes from the correction of anorectal malformations. Curr. Opin. Pediatrics. 17(3): 394-401. https://doi.org/10.1097/01.mop.0000163665.36798.ac; PMid:15891433
Levitt MA, Peña A. (2009). Complications of Surgery in Anorectal Malformations. Chapter 17. In: Caty M. G., editor. Complications in Pediatric Surgery. Informa Healthcare: 301-315. https://doi.org/10.3109/9781420016314-20
Levitt MA, Pena A. (2010). Pediatric fecal incontinence: a surgeon's perspective. Pediatr. Rev. 31: 91-101. https://doi.org/10.1542/pir.31.3.91; PMid:20194901
Mert M, Sayan A, Köylüoğlu G. (2021). Comparing the fecal continence scores of patients with anorectal malformation with anorectal manometric findings. Pediatr. Surg. Int. 37: 1013-1019. https://doi.org/10.1007/s00383-021-04884-4; PMid:33825956
Shimaru T, Fujiogi M, Michihata N et al. (2022). Perioperative outcomes of laparoscopically assisted anorectoplasty versus conventional procedures for anorectal malformation: a retrospective nationwide database study. Pediatr. Surg. Int. 38: 1785-1791. https://doi.org/10.1007/s00383-022-05234-8; PMid:36102983
Smith LE, Jorge JMN, Wexner SD. (1993). Etiology and management of fecal incontinence. Dis Colon Rectum. 36: 77-97. https://doi.org/10.1007/BF02050307; PMid:8416784
Svetanoff WJ, Kapalu CL, Lopez JJ et al. (2022). Psychosocial factors affecting quality of life in patients with anorectal malformation and Hirschsprung disease-a qualitative systematic review. J. Ped. Surg. 57(3): 387-393. https://doi.org/10.1016/j.jpedsurg.2021.05.004; PMid:34127258
Van der Steeg HJJ, Van Rooii IALM., Iacobelli BD et al. (2022). Bowel function and associated risk factors at preschool and early childhood age in children with anorectal malformation type rectovestibular fistula: An ARM-Net consortium study. J. Ped. Surg. 57(9): 89-96. https://doi.org/10.1016/j.jpedsurg.2022.02.015; PMid:35317943
Wehrli LA, Reppucci ML, Ketzer J et al. (2022). Stricture rate in patients after the repair of anorectal malformation following a standardized dilation protocol. Pediatr. Surg. Int. 38: 1717-1721. https://doi.org/10.1007/s00383-022-05219-7; PMid:36107235
Wigander H, Nisell M, Frenckner B, Wester T, Brodin U, Öjmyr-Joelsson M. (2019). Quality of life and functional outcome in Swedish children with low anorectal malformations: a follow-up study. Pediatric Surgery International. 35(5): 583-590. https://doi.org/10.1007/s00383-018-04431-8; PMid:30729983 PMCid:PMC6456466
Witvliet MJ, Slaar A, Heij HA, van der Steeg AF. (2013). Qualitative analysis of studies concerning quality of life in children and adults with anorectal malformations. J. Pediatr. Surg. 48: 372-379. https://doi.org/10.1016/j.jpedsurg.2012.11.018; PMid:23414868
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Paediatric Surgery (Ukraine)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The policy of the Journal “PAEDIATRIC SURGERY. UKRAINE” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license(СС BY-NC).
Authors transfer the copyright to the Journal “PAEDIATRIC SURGERY.UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.
