Anorectal malformation patients’ outcomes after definitive surgery using Krickenbeck classification: A cross-sectional study

Firdian Makrufardi,Dewi Novitasari Arifin,Dwiki Afandy,Dicky Yulianda,Andi Dwihantoro,Gunadi Gunadi

doi:10.1016/j.heliyon.2020.e03435

Firdian Makrufardi, Dewi Novitasari Arifin + Show 4 more

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https://doi.org/10.1016/j.heliyon.2020.e03435

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Journal: Heliyon	Publication Date: Feb 1, 2020
Citations: 9	License type: cc-by

Affiliation: Universitas Gadjah Mada

Abstract

BackgroundThe survival of anorectal malformation (ARM) patients has been improved in the last 10 years because of the improvement in management of neonatal care and surgical approaches for ARM patients. Thus, the current management of ARM patients are focusing on the functional outcomes after definitive surgery. Here, we defined the type of ARM and assessed the functional outcomes, including voluntary bowel movement (VBM), soiling, and constipation, in our patients following definitive surgery using Krickenbeck classification. MethodsWe conducted a cross-sectional study to retrospectively review medical records of ARM patients who underwent a definitive surgery at Dr. Sardjito Hospital, Indonesia, from 2011 to 2016. ResultsForty-three ARM patients were ascertained in this study, of whom 30 males and 13 females. Most patients (83.7%) were normal birth weight. There were ARM without fistula (41.9%), followed by rectourethral fistula (25.5%), perineal fistula (18.6%), vestibular fistula (9.3%), and rectovesical fistula (4.7%). The VBM was achived in 53.5% patients, while the soiling and constipation rates were 11.6% and 9.3%, respectively. Interestingly, patients with normal birth weight showed higher frequency of VBM than those with low birth weight (OR = 9.4; 95% CI = 1.0–86.9; p = 0.04), while male patients also had better VBM than females (OR = 3.9; 95% CI = 1.0–15.6) which almost reached a significant level (p = 0.09). However, VBM was not affected by ARM type (p = 0.26). Furthermore, there were no significant associations between gender, birth weight, and ARM type with soiling and constipation, with p-values of 1.0, 1.0, and 0.87; and 0.57, 1.0, and 0.94, respectively. ConclusionsFunctional outcomes of ARM patients in our hospital are considered relatively good with more than half of children showing VBM and only relatively few patients suffering from soiling and constipation. The frequency of VBM might be associated with birth weight and gender, but not ARM type, while the soiling and constipation did not appear to be correlated with birth weight, gender, nor ARM type. Further multicenter study is necessary to compare our findings with other centers.

Highlights

Anorectal malformation (ARM) is common congenital anomaly in newborns due to arrest of the caudal descent of the urorectal septum to the cloacal membrane
The voluntary bowel movement (VBM) was achived in 53.5% patients, while the soiling and constipation rates were 11.6% and 9.3%, respectively (Table 2)
Low birth weight is associated with malnutrition [8]. These conditions might be correlated with the less adequate innervation and inappropriate function of the pelvic floor, rectum, and anal spinchter, resulting in the worse VBM in anorectal malformation (ARM) infants with low birth weight compared with those with normal birth weight. In accordance with these findings, previous study found that the improvements of the survival in ARM patients increased with birth weight [9]

Summary

Introduction

Anorectal malformation (ARM) is common congenital anomaly in newborns due to arrest of the caudal descent of the urorectal septum to the cloacal membrane. The Krickenbeck classification is developed to determine the ARM diagnostic classification system, operative procedure category and functional outcomes of ARM patients after surgery [6]. According to the Krickenbeck classification, the functional outcomes of ARM patients following definitive operation consist of voluntary bowel movement (VBM), soiling, and constipation [6]. The survival of anorectal malformation (ARM) patients has been improved in the last 10 years because of the improvement in management of neonatal care and surgical approaches for ARM patients. We defined the type of ARM and assessed the functional outcomes, including voluntary bowel movement (VBM), soiling, and constipation, in our patients following definitive surgery using Krickenbeck classification. Conclusions: Functional outcomes of ARM patients in our hospital are considered relatively good with more than half of children showing VBM and only relatively few patients suffering from soiling and constipation. Further multicenter study is necessary to compare our findings with other centers

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Conclusion