Article ; Online: Treatment of megarectum in anorectal malformation with emphasis on preventive aspects: 17 years experience.
Pediatric surgery international
2020 Volume 36, Issue 8, Page(s) 933–940
Abstract: Purpose: Megarectum in anorectal malformation (ARM) causes severe morbidity. To compare conservative management (CM) of megarectum with excision (EX), to propose a new classification and to analyse management strategies.: Methods: Between 2000-2016, ... ...
| Abstract | Purpose: Megarectum in anorectal malformation (ARM) causes severe morbidity. To compare conservative management (CM) of megarectum with excision (EX), to propose a new classification and to analyse management strategies. Methods: Between 2000-2016, we reviewed all ARM to identify megarectum, defined by radiological recto-pelvic ratio > 0.61. A new classification was proposed: primary megarectum (PM) pre-anorectoplasty, and secondary megarectum (SM) post-anorectoplasty, with sub-types. Complications and Krickenbeck bowel function were compared between CM and EX. Results: Of 124 ARM, 22 (18%) developed megarectum; of these, 7 underwent EX. There was no difference in functional outcomes when comparing CM vs EX-voluntary bowel movement (both 86%), soiling (40% vs. 57%) and constipation (both 86%). However, EX was associated with major complications (43%) and the requirement for invasive bowel management, compared to CM (85% vs. 27%, P = 0.02). 6/7 EX needed antegrade continence enema (ACE), one of these has a permanent ileostomy. With strategic changes, incidence of megarectum reduced from 20/77 (26%) to 2/47 (4%) after 2013 (P = 0.002). Conclusion: EX did not confer benefit in the functional outcome but carried a high risk of complications, often needing ACE or stoma. By adhering to strategies discussed, we reduced the incidence of megarectum and have avoided EX since 2013. |
|---|---|
| MeSH term(s) | Anorectal Malformations/surgery ; Anorectal Malformations/therapy ; Child ; Child, Preschool ; Conservative Treatment/methods ; Female ; Humans ; Infant ; Male ; Prospective Studies ; Rectal Diseases/prevention & control ; Rectal Diseases/surgery ; Rectal Diseases/therapy ; Rectum/abnormalities ; Rectum/surgery ; Treatment Outcome |
| Language | English |
| Publishing date | 2020-06-01 |
| Publishing country | Germany |
| Document type | Journal Article |
| ZDB-ID | 632773-4 |
| ISSN | 1437-9813 ; 0179-0358 |
| ISSN (online) | 1437-9813 |
| ISSN | 0179-0358 |
| DOI | 10.1007/s00383-020-04687-z |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
Full text online
More links
Kategorien
In stock of ZB MED Cologne/Königswinter
| Zs.A 2138: Show issues | Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (1.OG) ab Jg. 2022: Lesesaal (EG) |
Order via subito
This service is chargeable due to the Delivery terms set by subito. Orders including an article and supplementary material will be classified as separate orders. In these cases, fees will be demanded for each order.