Ye Shiru,Zhou Yan,Zheng Chen,et al.Resection of distal 3 cm rectal pouch for high-and-intermediate anorectal malformation:medium-term outcomes from a propensity score matching analysis[J].Journal of Clinical Pediatric Surgery,,():355-360.[doi:10.3760/cma.j.cn101785-202403060-010]
Resection of distal 3 cm rectal pouch for high-and-intermediate anorectal malformation:medium-term outcomes from a propensity score matching analysis
- Keywords:
- Anorectal Malformations; Surgical Procedures; Operative; Treatment Outcome; Propensity Score; Child
- Abstract:
- Objective To evaluate the medium-term outcomes of resecting distal 3 cm of rectal pouch in children with congenital anorectal malformations (ARMs). Methods From January 2010 to December 2018,the relevant clinical data were retrospectively reviewed for 171 children with high-and-intermediate ARMs undergoing laparoscopic-assisted anorectoplasty.Based upon whether or not distal 3 cm rectal pouch was resected,they were divided into two groups of resection (n=120) and control (n=51).Baseline characteristics of two groups were matched with a ratio of 1∶1 using propensity score matching.No statistically significant difference existed in preoperative clinical data.Forty-six cases were included for each group and medium-term outcomes were compared between two groups. Results After propensity score matching,no statistically significant differences existed in operative duration,postoperative hospitalization stay or postoperative complication rate between resection and control groups (P>0.05).However,postoperative rectal retraction (n=1) and megarectosigmoid (n=1) during follow-ups in control group.The median follow-up period for both groups was 5.5 years and defecation function was evaluated by Krickenbeck scores.No significant inter-group difference existed in voluntary bowel movement or stool soiling.However,resection group exhibited a significantly a lower constipation rate than control group (47.0% vs.69.6%,P=0.014). Conclusions The constipation rate in ARM with distal 3cm resection is significantly lower without any increment of soiling.Excessive preservation of rectal pouch is one of the contributing factors to postoperative constipation in ARM children.It may be associated with residual fibrosis of rectal pouch.
References:
[1] van der Steeg HJJ,Botden SMBI,Sloots CEJ,et al.Outcome in anorectal malformation type rectovesical fistula:a nationwide cohort study in the Netherlands[J].J Pediatr Surg,2016,51(8):1229-1233.DOI:10.1016/j.jpedsurg.2016.02.002.
[2] Nam SH,Kim DY,Kim SC.Can we expect a favorable outcome after surgical treatment for an anorectal malformation?[J].J Pediatr Surg,2016,51(3):421-424.DOI:10.1016/j.jpedsurg.2015.08.048.
[3] Rigueros Springford L,Connor MJ,Jones K,et al.Prevalence of active long-term problems in patients with anorectal malformations:a systematic review[J].Dis Colon Rectum,2016,59(6):570-580.DOI:10.1097/DCR.0000000000000576.
[4] Zuccarello B,Romeo C,Scalfari GF,et al.Scintigraphic evaluation of colonic motility in patients with anorectal malformations and constipation[J].J Pediatr Surg,2006,41(2):310-313.DOI:10.1016/j.jpedsurg.2005.11.005.
[5] Xiao H,Huang R,Cui DX,et al.Histopathologic and immunohistochemical findings in congenital anorectal malformations[J].Medicine (Baltimore),2018,97(31):e11675.DOI:10.1097/MD.0000000000011675.
[6] 王琛,邹继珍,刘树立,等.中高位肛门闭锁末端肠壁异常与患儿术后排便功能的关系[J].中华普通外科杂志,2017,32(3):239-242.DOI:10.3760/cma.j.issn.1007-631X.2017.03.015. Wang C,Zou JZ,Liu SL,et al.Association between abnormalities of distal rectal pouch and postoperative bowel function in high/intermediate anal atresia[J].Chin J Gen Surg,2017,32(3):239-242.DOI:10.3760/cma.j.issn.1007-631X.2017.03.015.
[7] Lombardi L,Bruder E,Caravaggi F,et al.Abnormalities in "low" anorectal malformations (ARMs) and functional results resecting the distal 3 cm[J].J Pediatr Surg,2013,48(6):1294-1300.DOI:10.1016/j.jpedsurg.2013.03.026.
[8] Gangopadhyay AN,Upadhyaya VD,Gupta DK,et al.Histology of the terminal end of the distal rectal pouch and fistula region in anorectal malformations[J].Asian J Surg,2008,31(4):211-215.DOI:10.1016/S1015-9584(08)60089-5.
[9] Bhatia Y,Singh S,Rattan KN,et al.Anorectal malformations:histomorphological and immunohistochemical evaluation of neuronal dysfunction[J].J Neonatal Surg,2017,6(2):29.DOI:10.21699/jns.v6i2.559.
[10] 詹江华,胡博,罗喜荣,等.先天性肛门闭锁直肠远端切除范围的临床病理研究[J].中华小儿外科杂志,2011,32(2):54-156.DOI:10.3760/cma.j.issn.0253-3006.2011.02.019. Zhan JH,Hu B,Luo XR,et al.Clinicopathological study on resection extent of distal rectum in congenital anal atresia[J].Chin J Pediatr Surg,2011,32(2):54-156.DOI:10.3760/cma.j.issn.0253-3006.2011.02.019.
[11] Rintala R,Lindahl H,Marttinen E,et al.Constipation is a major functional complication after internal sphincter-saving posterior sagittal anorectoplasty for high and intermediate anorectal malformations[J].J Pediatr Surg,1993,28(8):1054-1058.DOI:10.1016/0022-3468(93)90518-p.
[12] Holschneider A,Hutson J,Pe?a A,et al.Preliminary report on the international conference for the development of standards for the treatment of anorectal malformations[J].J Pediatr Surg,2005,40(10):1521-1526.DOI:10.1016/j.jpedsurg.2005.08.002.
[13] De la Torre-Mondragón L,Ba?uelos-Casta?eda C,Santos-Jasso K,et al.Unexpected megarectum:a potential hidden source of complications in patients with anorectal malformation[J].J Pediatr Surg,2015,50(9):1560-1562.DOI:10.1016/j.jpedsurg.2015.05.004.
[14] Sharma N,Pratap A,Bajpai M.Rectal pouch index:a prognostic indicator for constipation after surgery for high and intermediate anorectal malformations[J].Eur J Pediatr Surg,2014,24(4):332-336.DOI:10.1055/s-0033-1347296.
[15] Cui Y,Wang RY,Zhang Y,et al.MRI findings in patients with defecatory dysfunction after surgical correction of anorectal malformation[J].Pediatr Radiol,2013,43(8):964-970.DOI:10.1007/s00247-013-2639-8.
[16] Levitt MA,Kant A,Pe?a A.The morbidity of constipation in patients with anorectal malformations[J].J Pediatr Surg,2010,45(6):1228-1233.DOI:10.1016/j.jpedsurg.2010.02.096.
[17] Tan YW,Yin KN,Chua AYT,et al.Treatment of megarectum in anorectal malformation with emphasis on preventive aspects:17 years experience[J].Pediatr Surg Int,2020,36(8):933-940.DOI:10.1007/s00383-020-04687-z.
[18] Midrio P,Trovalusci E,Zanatta C,et al.Should the search for ganglia in the distal rectal fistula in patients with anorectal malformation be abandoned?[J].J Pediatr Surg,2020,55(10):2166-2169.DOI:10.1016/j.jpedsurg.2020.03.021.
[19] Borg H,Bachelard M,Sillén U.Megarectosigmoid in children with anorectal malformations:long term outcome after surgical or conservative treatment[J].J Pediatr Surg,2014,49(4):564-569.DOI:10.1016/j.jpedsurg.2013.08.003.
[20] 施婷婷,刘振球,袁黄波,等.倾向性评分匹配法在非随机对照研究中的应用[J].中国卫生统计,2021,38(2):312-314.DOI:10.3969/j.issn.1002-3674.2021.02.040. Shi TT,Liu ZQ,Yuan HB,et al.Application of propensity score matching method in non-randomized controlled trials[J].Chin J Health Stat,2021,38(2):312-314.DOI:10.3969/j.issn.1002-3674.2021.02.040.
[21] Amae S,Hayashi J,Funakosi S,et al.Postoperative psychological status of children with anorectal malformations[J].Pediatr Surg Int,2008,24(3):293-298.DOI:10.1007/s00383-007-2077-5.
Memo
收稿日期:2023-07-31。
基金项目:中国医学科学院小儿外科微创诊疗创新单元(2021RU015)
通讯作者:李龙,Email:lilong23@126.com