Yokoyama Shinichiro, Ishii Daisuke, Sakamura Soma, Kawahara Insu, Hashimoto Satsuki, Kumata Yuka, Korai Takahiro, Okumura Kazuyoshi, Ara Momoko, Kondo Takafumi, Ishimura Riku, Takahashi Ryo, Tsuzaka Shoichi, Minato Masashi, Ohba Go, Yamamoto Hiroshi, Honda Shohei, Miyagi Hisayuki, Nui Akihiro
Department of Pediatric Surgery, Hokkaido Medical Center for Child Health and Rehabilitation, 1-1-240-6, Kanayama, Teine-ku, Sapporo, Hokkaido, 006-0041, Japan.
Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, Asahikawa, Japan.
Pediatr Surg Int. 2024 Dec 21;41(1):41. doi: 10.1007/s00383-024-05953-0.
This study aimed to identify surgical site infection (SSI) risk factors after anal reconstruction surgery in patients with anorectal malformations (ARMs).
This retrospective analysis from January 2013 to December 2022, including all pediatric surgical facilities in Hokkaido, Japan, examined consecutive patients with ARMs, excluding cloacal cases, regarding perioperative and SSI factors during their initial anal reconstruction surgeries.
This study involved 157 cases of major clinical groups and 7 cases of rare/regional variants, among whom 4% developed SSIs. SSIs occurrence varied by type and was primarily observed from the neo-anus to the perineal region. Organ/space SSIs occurred in rectourethral fistula (prostatic/bulbar) and perineal (cutaneous) fistula type. Surgical procedures were abdominal sacroperineal rectoplasty, posterior sagittal anorectoplasty, laparoscopic-assisted anorectal pull-through, cutback anoplasty, and Pott's anoplasty, varied based on the ARM type and facility. In perineal (cutaneous) fistula, vestibular fistula, and anal stenosis cases, a significant association was observed between perianal muscle division and SSIs in patients aged > 4 months (p = 0.04). No significant SSI factors were found in other ARM types.
The choice of procedure as an interventional perioperative factor is suggested to be associated with SSIs. These findings may contribute to making informed decisions regarding surgical procedures in such cases.
本研究旨在确定肛门直肠畸形（ARM）患者肛门重建手术后手术部位感染（SSI）的危险因素。
这项回顾性分析涵盖了2013年1月至2022年12月期间日本北海道所有儿科外科机构，研究了连续的ARM患者（不包括泄殖腔病例）在初次肛门重建手术期间的围手术期和SSI相关因素。
本研究纳入了157例主要临床组病例和7例罕见/区域变异病例，其中4%发生了SSI。SSI的发生率因类型而异，主要发生在新肛门至会阴区域。器官/腔隙性SSI发生在直肠尿道瘘（前列腺/球部）和会阴（皮肤）瘘类型中。手术方式包括腹骶会阴直肠成形术、后矢状位肛门直肠成形术、腹腔镜辅助肛门直肠拖出术、回切肛门成形术和波特氏肛门成形术，根据ARM类型和机构的不同而有所变化。在会阴（皮肤）瘘、前庭瘘和肛门狭窄病例中，观察到年龄>4个月的患者肛周肌肉切开与SSI之间存在显著关联（p = 0.04）。在其他ARM类型中未发现显著的SSI危险因素。
作为围手术期干预因素的手术方式选择被认为与SSI有关。这些发现可能有助于在此类病例中就手术方式做出明智的决策。
