Bowel function and associated risk factors at preschool and early childhood age in children with anorectal malformation type rectovestibular fistula: An ARM-Net consortium study

Space: StayCurrentMD Author: Hendrick J.J. van der Steeg, Iris A.L.M. van Rooij, Barbara D. Iacobelli, Cornelius E.J. Sloots, Anna Morandi, Paul M.A. Broens, Igor Makedonsky, Francesco Fascetti Leon, Eberhard Schmiedeke, Araceli García Vázquez, Marc Miserez, Gabriele Lisi, Paola Midr Published: 2022-02-20

Author / Expert

Hendrick J.J. van der Steeg, Iris A.L.M. van Rooij, Barbara D. Iacobelli, Cornelius E.J. Sloots, Anna Morandi, Paul M.A. Broens, Igor Makedonsky, Francesco Fascetti Leon, Eberhard Schmiedeke, Araceli García Vázquez, Marc Miserez, Gabriele Lisi, Paola Midr

Topic overview

Abstract

Background

Outcome of patients operated for anorectal malformation (ARM) type rectovestibular fistula (RVF) is generally considered to be good. However, large multi-center studies are scarce, mostly describing pooled outcome of different ARM-types, in adult patients. Therefore, counseling parents concerning the bowel function at early age is challenging. Aim of this study was to evaluate bowel function of RVF-patients at preschool/early childhood age and determine risk factors for poor functional outcome.

Methods

A multi-center cohort study was performed. Patient characteristics, associated anomalies, sacral ratio, surgical procedures, post-reconstructive complications, one-year constipation, and Bowel Function Score (BFS) at 4-7 years of follow-up were registered. Groups with below normal (BFS < 17; subgroups ‘poor' ≤ 11, and ‘fair' 11 < BFS < 17) and good outcome (BFS ≥ 17) were formed. Univariable analyses were performed to detect risk factors for outcome.

Results

The study included 111 RVF-patients. Median BFS was 16 (range 6-20). The ‘below normal' group consisted of 61 patients (55.0%). Overall, we reported soiling, fecal accidents, and constipation in 64.9%, 35.1% and 70.3%, respectively. Bowel management was performed in 23.4% of patients. Risk factors for poor outcome were tethered cord and low sacral ratio, while sacral anomalies, low sacral ratio, prior enterostomy, post-reconstructive complications, and one-year constipation were for being on bowel management .

Conclusions

Although median BFS at 4-7 year follow-up is nearly normal, the majority of patients suffers from some degree of soiling and constipation, and almost 25% needs bowel management. Several factors were associated with poor bowel function outcome and bowel management.