TY - JOUR
T1 - Classification and Surgical Management of Anorectal Malformations
T2 - A Systematic Review and Evidence-based Guideline From the APSA Outcomes and Evidence-based Practice Committee
AU - the APSA Outcomes and Evidence Based Practice Committee
AU - Smith, Caitlin A.
AU - Rialon, Kristy L.
AU - Kawaguchi, Akemi
AU - Dellinger, Matthew B.
AU - Goldin, Adam B.
AU - Acker, Shannon
AU - Kulaylat, Afif N.
AU - Chang, Henry
AU - Russell, Katie
AU - Wakeman, Derek
AU - Derderian, S. Christopher
AU - Englum, Brian R.
AU - Polites, Stephanie F.
AU - Lucas, Donald J.
AU - Ricca, Robert
AU - Levene, Tamar L.
AU - Sulkowski, Jason P.
AU - Kelley-Quon, Lorraine I.
AU - Tashiro, Jun
AU - Christison-Lagay, Emily R.
AU - Mansfield, Sara A.
AU - Beres, Alana L.
AU - Huerta, Carlos T.
AU - Ben Ham, P.
AU - Yousef, Yasmine
AU - Rentea, Rebecca M.
N1 - Publisher Copyright:
© 2024 Elsevier Inc.
PY - 2024/10
Y1 - 2024/10
N2 - Objective: Treatment of neonates with anorectal malformations (ARMs) can be challenging due to variability in anatomic definitions, multiple approaches to surgical management, and heterogeneity of reported outcomes. The purpose of this systematic review is to summarize existing evidence, identify treatment controversies, and provide guidelines for perioperative care. Methods: The American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee (OEBP) drafted five consensus-based questions regarding management of children with ARMs. These questions were related to categorization of ARMs and optimal methods and timing of surgical management. A comprehensive search strategy was performed, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to perform the systematic review to attempt to answer five questions related to surgical care of ARM. Results: A total of 10,843 publications were reviewed, of which 90 were included in final recommendations, and some publications addressed more than one question (question: 1 n = 6, 2 n = 63, n = 15, 4 n = 44). Studies contained largely heterogenous groups of ARMs, making direct comparison for each subtype challenging and therefore, no specific recommendation for optimal surgical approach based on outcomes can be made. Both loop and divided colostomy may be acceptable methods of fecal diversion for patients with a diagnosis of anorectal malformation, however, loop colostomies have higher rates of prolapse in the literature reviewed. In terms of timing of repair, there did not appear to be significant differences in outcomes between early and late repair groups. Clear and uniform definitions are needed in order to ensure similar populations of patients are compared moving forward. Recommendations are provided based primarily on A-D levels of evidence. Conclusions: Evidence-based best practices for ARMs are lacking for many aspects of care. Multi-institutional registries have made progress to address some of these gaps. Further prospective and comparative studies are needed to improve care and provide consensus guidelines for this complex patient population. Level of Evidence: 3.
AB - Objective: Treatment of neonates with anorectal malformations (ARMs) can be challenging due to variability in anatomic definitions, multiple approaches to surgical management, and heterogeneity of reported outcomes. The purpose of this systematic review is to summarize existing evidence, identify treatment controversies, and provide guidelines for perioperative care. Methods: The American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee (OEBP) drafted five consensus-based questions regarding management of children with ARMs. These questions were related to categorization of ARMs and optimal methods and timing of surgical management. A comprehensive search strategy was performed, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to perform the systematic review to attempt to answer five questions related to surgical care of ARM. Results: A total of 10,843 publications were reviewed, of which 90 were included in final recommendations, and some publications addressed more than one question (question: 1 n = 6, 2 n = 63, n = 15, 4 n = 44). Studies contained largely heterogenous groups of ARMs, making direct comparison for each subtype challenging and therefore, no specific recommendation for optimal surgical approach based on outcomes can be made. Both loop and divided colostomy may be acceptable methods of fecal diversion for patients with a diagnosis of anorectal malformation, however, loop colostomies have higher rates of prolapse in the literature reviewed. In terms of timing of repair, there did not appear to be significant differences in outcomes between early and late repair groups. Clear and uniform definitions are needed in order to ensure similar populations of patients are compared moving forward. Recommendations are provided based primarily on A-D levels of evidence. Conclusions: Evidence-based best practices for ARMs are lacking for many aspects of care. Multi-institutional registries have made progress to address some of these gaps. Further prospective and comparative studies are needed to improve care and provide consensus guidelines for this complex patient population. Level of Evidence: 3.
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U2 - 10.1016/j.jpedsurg.2024.06.007
DO - 10.1016/j.jpedsurg.2024.06.007
M3 - Review article
C2 - 38997855
AN - SCOPUS:85198372507
SN - 0022-3468
VL - 59
JO - Journal of pediatric surgery
JF - Journal of pediatric surgery
IS - 10
M1 - 161598
ER -