Hu Wenshu,Li Long.Prognostic observation of rectal prolapse after surgery for congenital anorectal malformations and analysis of risk factors for recurrence[J].Journal of Clinical Pediatric Surgery,,():729-733.[doi:10.3760/cma.j.cn101785-202504066-005]
Prognostic observation of rectal prolapse after surgery for congenital anorectal malformations and analysis of risk factors for recurrence
- Abstract:
- Objective To evaluate the prognosis of anorectal prolapse (ARP) following surgery for congenital anorectal malformations (ARMs) and to analyze the risk factors associated with ARP recurrence. Methods A retrospective analysis was conducted on 114 pediatric patients with ARP following ARMs surgery,treated in the Department of Pediatric Surgery at the Capital Center for Children‘s Health,Capital Medical University,between January 2015 and June 2024.Postoperative complications were followed up,and bowel function was assessed using the Rintala score and Krickenbeck classification.Patients were divided into groups based on whether ARP recurred,and risk factors for recurrence were analyzed. Results Among the 114 patients treated for ARP after ARMs surgery,56 had good bowel function,51 had average function,and 7 had poor function following reoperation.Postoperative complications included infection (n=10),ARP recurrences (n=9),secondary megacolon (n=2),severe constipation (n=8),and fecal incontinence (n=5).Univariate analysis identified spinal cord dysplasia,simultaneous colostomy closure during ARP surgery,and the age at ARP surgery as factors associated with recurrence (P＜0.05).Multivariate logistic regression analysis showed spinal cord dysplasia (OR=5.457,95%CI:1.175-25.342) and younger age at ARP surgery (OR=0.273,95%CI:0.076-0.979) were independent risk factors for recurrence (P＜0.05). Conclusions Recurrence of ARP after ARMs surgery is closely related to the young age of ARP surgery and spinal cord dysplasia.Conservative management is recommended for asymptomatic ARP in young children.Individualized surgical strategies focused on correcting structural abnormalities may reduce recurrence rates,and enhanced postoperative bowel management is essential to improve outcomes.
References:
[1] Belizon A,Levitt M,Shoshany G,et al.Rectal prolapse following posterior sagittal anorectoplasty for anorectal malformations[J].J Pediatr Surg,2005,40(1):192-196.DOI:10.1016/j.jpedsurg.2004.09.035.
[2] Ishimaru T,Hosokawa T,Kawashima H,et al.Rectal prolapse after laparoscopically assisted anorectoplasty for anorectal malformations[J].J Laparoendosc Adv Surg Tech A,2020,30(12):1277-1281.DOI:10.1089/lap.2020.0609.
[3] Iantorno SE,Rollins MD,Austin K,et al.Rectal prolapse following repair of anorectal malformation:incidence,risk factors,and management[J].J Pediatr Surg,2023,58(8):1588-1593.DOI:10.1016/j.jpedsurg.2023.04.010.
[4] Li L,Zhou Y,Ming AX,et al.Pattern of anatomic disorder and surgical management of anorectal prolapse in anorectal malformation[J].Pediatr Surg Int,2022,38(7):993-1004.DOI:10.1007/s00383-022-05141-y.
[5] Wood RJ,Halleran DR,Ahmad H,et al.Assessing the benefit of reoperations in patients who suffer from fecal incontinence after repair of their anorectal malformation[J].J Pediatr Surg,2020,55(10):2159-2165.DOI:10.1016/j.jpedsurg.2020.06.011.
[6] De La Torre L,Zornoza M,Pe?a A,et al.Transanal rectal mucosectomy and muscular plication:A new technique for rectal prolapse in patients with an anorectal malformation[J].J Pediatr Surg,2020,55(11):2531-2535.DOI:10.1016/j.jpedsurg.2020.05.025.
[7] Sato H,Furuta S,Kawase H,et al.The long-term prognosis of two-flap anoplasty for mucosal prolapse following anorectoplasty for anal atresia[J].Pediatr Surg Int,2012,28(8):841-846.DOI:10.1007/s00383-012-3129-z.
[8] Caouette-Laberge L,Yazbeck S,Laberge JM,et al.Multiple-flap anoplasty in the treatment of rectal prolapse after pull-through operations for imperforate anus[J].J Pediatr Surg,1987,22(1):65-67.DOI:10.1016/s0022-3468(87)80018-0.
[9] Duthie HL,Gairns FW.Sensory nerve-endings and sensation in the anal region of man[J].Br J Surg,1960,47:585-595.DOI:10.1002/bjs.18004720602.
[10] Rintala RJ,Lindahl HG,Rasanen M.Do children with repaired low anorectal malformations have normal bowel function?[J].J Pediatr Surg,1997,32(6):823-826.DOI:10.1016/S0022-3468(97)90628-X.
[11] 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.
[12] Brisighelli G,Di Cesare A,Morandi A,et al.Classification and management of rectal prolapse after anorectoplasty for anorectal malformations[J].Pediatr Surg Int,2014,30(8):783-789.DOI:10.1007/s00383-014-3533-7.
[13] 王献良,孙忠源,穆鑫,等.腹腔镜下肛门直肠畸形术后再手术原因分析及对策[J].中华小儿外科杂志,2021,42(2):109-113.DOI:10.3760/cma.j.cn421158-20191105-00622. Wang XL,Sun ZY,Mu X,et al.Causes and countermeasures of reoperation after laparoscopic anorectoplasty of anorectal malformations[J].Chin J Pediatr Surg,2021,42(2):109-113.DOI:10.3760/cma.j.cn421158-20191105-00622.
[14] Jung SM,Lee SK,Seo JM.Experience with laparoscopic-assisted anorectal pull-through in 25 males with anorectal malformation and rectourethral or rectovesical fistulae:postoperative complications and functional results[J].J Pediatr Surg,2013,48(3):591-596.DOI:10.1016/j.jpedsurg.2012.08.001.
Memo
收稿日期:2025-4-28。
基金项目:中国医学科学院小儿外科微创诊疗创新单元项目(2021RU015)
通讯作者:李龙,Email:lilong23@126.com