Background
Routine post operative anal dilatations have been standard practice in the management of anorectal malformations (ARM) since 1982. Recent studies, however, have questioned their necessity and effectiveness. This systematic review aimed to synthesise the available literature pertaining to the effectiveness of routine post operative dilatations in preventing anal strictures following ARM surgery.
Methods
A systematic search of Cochrane Library, PubMed, Medline, and EMBASE databases was conducted for English-language articles published between January 1990 and December 2023. Studies reporting on children with ARM who underwent reconstructive surgery, followed by anal dilatations, were included. The primary outcome was the development of anal strictures.
Results
Seven studies met the inclusion criteria. Of the 400 patients, 311 (77.7 %) patients received routine post operative dilatations (RPD). Stricture rates ranged widely, with the Peña protocol, considered standard practice, resulting in stricture rates between 0 % and 39 %. Alternative approaches showed similar outcomes: daily non-Hegar dilatations (using digital manipulation or candles) resulted in stricture rates of 0–22 %, while weekly dilatations performed by surgeons showed rates of 15–18 %. In the single randomised controlled trial that included a non-dilatation group, comparable stricture rates were observed between patients who received dilatations (21 %) and those who did not (24 %). The heterogeneity in study designs, populations, and outcome measures limited direct comparisons.
Conclusion
While RPDs have been the standard of care, the available evidence suggests that their universal necessity may be questioned. Alternative approaches appear to achieve comparable outcomes, however the variability in available evidence and lack of large-scale randomised trials both highlight the need for further research to guide evidence-based practice in post operative care for ARM patients.
Type: video · 0 min · posted 2025-09-23
Canonical: https://library.globalcastmd.com/watch/post-operative-anal-dilatations-for-the-prevention-of-anal-strictures-in-children-with-anorectal-malformation-a-systematic-review-11031
## Chapters
- [0:00](https://library.globalcastmd.com/watch/post-operative-anal-dilatations-for-the-prevention-of-anal-strictures-in-children-with-anorectal-malformation-a-systematic-review-11031?t=0) Questioning Routine Anal Dilatations After ARM Surgery
## Statements
- "Routine anal dilatations after surgery for anorectal malformations have been standard since the 1980s" — Lizzie Lee (clinical) [0:11](https://library.globalcastmd.com/watch/post-operative-anal-dilatations-for-the-prevention-of-anal-strictures-in-children-with-anorectal-malformation-a-systematic-review-11031?t=11)
- "Stricture rates after anorectal malformation surgery range from 0 to almost 40%, even with the classic Pena protocol" — Lizzie Lee (epidemiological) [0:18](https://library.globalcastmd.com/watch/post-operative-anal-dilatations-for-the-prevention-of-anal-strictures-in-children-with-anorectal-malformation-a-systematic-review-11031?t=18)
- "Alternative methods like weekly dilatations or skipping dilatations altogether showed similar outcomes to standard protocols" — Lizzie Lee (clinical) [0:25](https://library.globalcastmd.com/watch/post-operative-anal-dilatations-for-the-prevention-of-anal-strictures-in-children-with-anorectal-malformation-a-systematic-review-11031?t=25)
- "There is insufficient high quality evidence proving that dilatations after anorectal malformation surgery are actually necessary" — Lizzie Lee (opinion) [0:32](https://library.globalcastmd.com/watch/post-operative-anal-dilatations-for-the-prevention-of-anal-strictures-in-children-with-anorectal-malformation-a-systematic-review-11031?t=32)
- "More randomized trials are needed to determine whether post-operative anal dilatations are necessary" — Lizzie Lee (opinion) [0:37](https://library.globalcastmd.com/watch/post-operative-anal-dilatations-for-the-prevention-of-anal-strictures-in-children-with-anorectal-malformation-a-systematic-review-11031?t=37)
## Transcript
After reconstructive surgery for anorectal malformations, dilatations are routine, but are they actually necessary? I'm Lizzie Lee from Cincinnati Children's, and this is an article you should know about. Since the 1980s, routine anal dilatations after surgery for anorectal malformations have been standard. But this new study showed that stricture rates range from 0 to almost 40%, even with the classic Pena protocol. In addition, alternative methods like weekly dilatations or even skipping dilatations altogether showed similar outcomes. So there isn't enough high quality evidence proving that dilatations are actually necessary. Bottom line, we might have been doing this for decades without really needing to, and we need more randomized trials to settle the debate. Let us know what you think in the comments below and stay tuned for more articles that you should know about.
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Not medical advice · citation policy: https://library.globalcastmd.com/ai