Dilations after Posterior Sagital Anorectoplasty
Topic overview
Randomized controlled trial challenges the four-decade practice of routine postoperative anal dilations following PSARP for anorectal malformations. Study of 49 patients found no significant difference in stricture rates between dilation and non-dilation groups, suggesting non-dilation is a viable alternative with anoplasty as backup.
Key takeaways
- Routine daily anal dilations after PSARP do not significantly reduce stricture formation (21% vs 32%, p=0.21)
- Non-dilation is a viable alternative approach, reducing psychological burden on patients and families
- Heineke-Mikulicz anoplasty remains an effective backup intervention for strictures that do develop (13% vs 16% required HMA)
- Stricture rates requiring surgical intervention were similar between dilation and non-dilation groups (p=0.72)
- This RCT challenges four decades of standard practice, suggesting selective rather than routine dilation protocols
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