Mullassery Dhanya, Chhabra Sumita, Babu Ashik Muhamed, Iacona Roberta, Blackburn Simon, Cross Kate M, De Coppi Paolo, Baillie Colin Tennant, Kenny Simon, Curry Joe I
Department of Paediatric Surgery, Great Ormond Street Hospital, London, United Kingdom.
Department of Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom.
Eur J Pediatr Surg. 2019 Jun;29(3):243-246. doi: 10.1055/s-0038-1632392. Epub 2018 Feb 28.
Regular anal dilatations are commonly recommended in the postoperative management following posterior sagittal anorectoplasty (PSARP) in anorectal malformations (ARM). We hypothesized that routine postoperative dilatations may not affect surgical outcomes following PSARP. We compare surgical outcomes of routine postoperative dilatations versus no routine postoperative dilatations from two United Kingdom tertiary pediatric surgical centers.
This is retrospective records review of patients undergoing definitive surgery for ARM in two tertiary surgical centers in the UK over 5 years. Center A used a protocol of routine postoperative dilatations, and center B used a protocol, which used dilatations only for clinical indications of stricture. Data collected included ARM type, operative procedures, and postoperative interventions. All post-operative interventions under general anesthesia (GA) were compared between groups.
From 2011 to 2015, 49 procedures (46 PSARPs) were performed in center A and 54 (52 PSARPs) in center B. Median follow up period was 31 months (interquartile range [IQR] 18-48). The first postoperative anal calibration under GA was documented for 43 (86%) patients in center A and for 42 (78%) patients in center B. Following this, center A followed routine postoperative dilatation (RPD) at home, and center B reserved further dilatations for specific indications. RPD was performed for 100% of patients in center A versus 8% in center B. Further anal dilatations under GA were performed in 19 (38%) children in center A and in 17 (34%) children in center B ( = 0.68). In center A, 10 patients (22%) needed further surgery versus 14 (28%) in center B ( = 0.48).
The use of routine postoperative dilatations does not significantly improve surgical outcomes following PSARP in ARM.
在肛门直肠畸形（ARM）的后矢状入路肛门直肠成形术（PSARP）后的术后管理中，通常推荐定期进行肛门扩张。我们推测，PSARP术后常规扩张可能不会影响手术效果。我们比较了英国两个三级儿科手术中心常规术后扩张与非常规术后扩张的手术效果。
这是一项对英国两个三级手术中心5年内接受ARM确定性手术的患者进行的回顾性记录审查。中心A采用常规术后扩张方案，中心B采用仅在出现狭窄临床指征时进行扩张的方案。收集的数据包括ARM类型、手术操作和术后干预措施。比较了两组在全身麻醉（GA）下的所有术后干预措施。
2011年至2015年，中心A进行了49例手术（46例PSARP），中心B进行了54例（52例PSARP）。中位随访期为31个月（四分位间距[IQR]18 - 48）。中心A有43例（86%）患者记录了首次GA下的术后肛门扩肛，中心B有42例（78%）患者记录了该操作。在此之后，中心A在患者家中进行常规术后扩张（RPD），中心B仅在特定指征下进行进一步扩张。中心A 100%的患者进行了RPD，而中心B为8%。中心A有19例（38%）儿童接受了进一步的GA下肛门扩张，中心B有17例（34%）儿童接受了该操作（P = 0.68）。中心A有10例（22%）患者需要进一步手术，中心B有14例（28%）患者需要进一步手术（P = 0.48）。
在ARM的PSARP术后，使用常规术后扩张并不能显著改善手术效果。
