When do you repair an anorectal malformation? | 5-year retrospective review of kids who underwent repair for ARM with perineal or vestibular fistula | Total of 291 patients received ARM repair & compared | EARLY vs LATE | (<7d) | (6wk-8mo) | But no significant difference in 30 day complication rate between groups. | Multivariate analysis: timing of repair DOES NOT affect 30 day complications | Shorter mean operative time in the EARLY group (90.1 vs 129.6 min; p<0.01) | Comparing 30-day outcomes between early versus delayed repair of anorectal malformations with perineal or rectovestibular fistulas: An analysis of the ACS NSQIP-Pediatric database | Ifran et al. DOI: 10.1016/j.jpedsurg.2020.09.002 | Stay current INFOGRAPHICS | Cincinnati Children's | Pediatric Surgery
When do you repair an anorectal malformation?
Infographic · Aug 2021 · 1 min read
In brief
In brief
NSQIP-P database analysis of 291 patients comparing early (≤7 days) versus delayed (6 weeks-8 months) repair of low anorectal malformations found no significant difference in 30-day complications. Early repair showed shorter operative times and appears safe, though timing decisions remain surgeon-dependent.
- Early repair (≤7 days) of low ARMs with perineal/vestibular fistulas shows no increased 30-day complication risk versus delayed repair (6wks-8mo)
- Early repair group had significantly shorter operative times (90 vs 130 minutes) despite higher rates of cardiac comorbidities
- NSQIP-P data (291 patients) supports safety of neonatal repair for select low ARMs when surgeon experience permits
- Timing decision remains surgeon-dependent; both early and delayed approaches yield comparable short-term outcomes for low-complexity defects
Written by the GCMD Library team from the infographic.
The infographic uses a teal background with white text boxes arranged in a grid layout. The left side features an anatomical cross-section illustration of the pelvic region showing anorectal anatomy. The center and right sections contain patient icons, a clock illustration, and a data visualization icon. Color coding emphasizes key findings with white boxes for main results.
Background
Anorectal malformations (ARMs) have a wide spectrum of presentation ranging from mild defects with perineal fistulas to more severe defects requiring complex management. A primary repair of ARMs with perineal or rectovestibular fistulas has been shown to have good outcomes. However, the timing of the reconstruction is still debated. The aim of this study is to investigate the safety of early versus delayed repair.
Methods
This study was performed using data from the National Surgical Quality Improvement Program-Pediatric (NSQIP-P) from 2012 to 2017. Patients who underwent repair of anorectal malformation with perineal or vestibular fistula were included in the study. Patients with associated diagnosis for Hirschsprung disease, cloaca, rectal prolapse or stenosis, bladder exstrophy, and tracheoesophageal fistula were excluded. 30-day postoperative outcomes included wound and nonwound complications, readmissions, and reoperations. Outcomes were compared by early (≤7 days of age) versus delayed repair (6 weeks to 8 months).
Results
A total of 291 patients were included, with 66 in the early and 231 in the delayed group. Patients in the early group were more likely to be male (68.2% vs 31.8%; p < 0.01) and have cardiac risk factors (71.2% vs 49.4%, p < 0.01). The mean operative time was significantly shorter in the early group (90.1 vs 129.6 min; p < 0.01). 30-day complications were not statistically significant between the two groups (p = 0.76). After multivariate analysis, timing of repair did not affect 30-day complications (p = 0.15).
Conclusion
Our study shows that early repair of low anorectal malformations with a perineal or vestibular fistula appears to be associated with no increase in risk of postoperative complications as compared to delayed repair. At present, the decision remains dependent on the surgeon's experience and judgment.