Journal article
Classification fi cation and Surgical Management of Anorectal Malformations: A Systematic Review and Evidence-based Guideline From the APSA Outcomes and Evidence-based Practice Committee
Journal of pediatric surgery, v 59(10), 161598
01 Oct 2024
PMID: 38997855
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
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. (c) 2024 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.
Metrics
Details
- Title
- Classification fi cation and Surgical Management of Anorectal Malformations: A Systematic Review and Evidence-based Guideline From the APSA Outcomes and Evidence-based Practice Committee
- Creators
- Caitlin A. Smith - Seattle Children's HospitalKristy L. Rialon - Baylor College of MedicineAkemi Kawaguchi - The University of Texas Health Science Center at HoustonMatthew B. Dellinger - Seattle Children's HospitalAdam B. Goldin - Seattle Children's HospitalShannon Acker - University of Colorado DenverAfif N. Kulaylat - Penn State Milton S. Hershey Medical CenterHenry Chang - Johns Hopkins All Children's HospitalKatie Russell - University of UtahDerek Wakeman - University of RochesterS. Christopher Derderian - Children's Hospital ColoradoBrian R. Englum - University of Maryland, BaltimoreStephanie F. Polites - Mayo Clinic in ArizonaDonald J. Lucas - Uniformed Services University of the Health SciencesRobert Ricca - University of South CarolinaTamar L. Levene - Joe DiMaggio Children's HospitalJason P. Sulkowski - Children's Hospital of Richmond at VCULorraine I. Kelley-Quon - Children's Hospital of Los AngelesJun Tashiro - NYU Langone Hlth, Hassenfeld Childrens Hosp, New York, NY USAEmily R. Christison-Lagay - Yale New Haven HospitalSara A. Mansfield - Nationwide Children's HospitalAlana L. Beres - St. Christopher's Hospital for ChildrenCarlos T. Huerta - University of MiamiP. Ben Ham III - University at Buffalo, State University of New YorkYasmine Yousef - Montreal Children's HospitalRebecca M. Rentea - Children's Mercy HospitalAPSA Outcomes Evidence Based Practice Comm
- Publication Details
- Journal of pediatric surgery, v 59(10), 161598
- Publisher
- Elsevier
- Number of pages
- 12
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:001317516400001
- Scopus ID
- 2-s2.0-85198372507
- Other Identifier
- 991021969586804721
UN Sustainable Development Goals (SDGs)
This publication has contributed to the advancement of the following goals:
InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Pediatrics
- Surgery