Multi-institutional review of bowel management strategies in children with anorectal malformations
jpedsurg.org shows its articles on its own site.
Read the article on jpedsurg.org ↗Article · Jun 2020 · 1 min read
In brief
In brief
Multi-institutional study of 624 ARM patients examining bowel management strategies across age groups and anomaly severity. Two-thirds required structured programs, with constipation as primary complaint and ACE utilization increasing with age and anatomic complexity.
Written by the GCMD Library team from the article.
Abstract
Background/rationale
To describe current bowel management program (BMP) strategies in anorectal malformation (ARM) patients based on patient-level predictors using data from a multi-institutional consortium.
Materials/Methods
Patient bowel function and BMP were reviewed from Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) data. The PCPLC is comprised of multidisciplinary specialists researching colorectal and pelvic disorders. Seven US institutions submitted de-identified clinical data on ARM patients into a centralized patient registry.
Results
The primary ARM of 624 patients was categorized into Mild (45.2%), Moderate (40.4%) or Complex (14.2%) anomaly classifications. Patient-specific BMP were examined based on age and on the presence of spinal cord/sacral anomalies.
418 (67%) enrolled patients were prescribed BMP (<5 yo 56.4%; ≥5–<12 yo 86.7%; ≥12 81.5%). Constipation was the primary chief complaint (80.2%). Forty percent of patients on a BMP were toilet trained and approximately one-half (48.5%) reported daytime stool accidents.
Secondary surgical interventions for antegrade continence enemas (ACE) were examined; 14.5% of patients employed ACE strategies and utilization increased with age and varied based on anatomic anomalies.
Conclusions
This is the first report on BMP strategies for patients with ARM from the Pediatric Colorectal and Pelvic Learning Consortium. Individual patient characteristics are explored for their impact on bowel management strategy utilization.
Level of Evidence
IV