Role of Routine Dilatations after Anorectal Reconstruction—Comparison of Two Tertiary Centers
dx.doi.org shows its articles on its own site.
Read the article on dx.doi.org ↗Article · Feb 2018 · 1 min read
In brief
In brief
Retrospective comparison of 103 pediatric patients across two UK centers found that routine postoperative anal dilatations following PSARP for anorectal malformations did not reduce the need for subsequent procedures under general anesthesia or additional surgery compared to dilatations performed only for clinical indications of stricture.
Written by the GCMD Library team from the article.
Aim Regular anal dilatations are commonly recommended in the postoperative management following posterior sagittal anorectoplasty (PSARP) in anorectal malformations (ARM). We hypothesized that routine postoperative dilatations may not affect surgical outcomes following PSARP. We compare surgical outcomes of routine postoperative dilatations versus no routine postoperative dilatations from two United Kingdom tertiary pediatric surgical centers.
Methods This is retrospective records review of patients undergoing definitive surgery for ARM in two tertiary surgical centers in the UK over 5 years. Center A used a protocol of routine postoperative dilatations, and center B used a protocol, which used dilatations only for clinical indications of stricture. Data collected included ARM type, operative procedures, and postoperative interventions. All post-operative interventions under general anesthesia (GA) were compared between groups.
Results From 2011 to 2015, 49 procedures (46 PSARPs) were performed in center A and 54 (52 PSARPs) in center B. Median follow up period was 31 months (interquartile range [IQR] 18–48). The first postoperative anal calibration under GA was documented for 43 (86%) patients in center A and for 42 (78%) patients in center B. Following this, center A followed routine postoperative dilatation (RPD) at home, and center B reserved further dilatations for specific indications. RPD was performed for 100% of patients in center A versus 8% in center B. Further anal dilatations under GA were performed in 19 (38%) children in center A and in 17 (34%) children in center B (p = 0.68). In center A, 10 patients (22%) needed further surgery versus 14 (28%) in center B (p = 0.48).
Conclusion The use of routine postoperative dilatations does not significantly improve surgical outcomes following PSARP in ARM.