Barros Ana Isabel, Correia Mário Rui, Carvalho Fátima, Bonet Berta, Carvalho Catarina
Department of Pediatric Surgery of Centro Hospitalar Universitário de Santo António, Unidade Local de Saúde de Santo António, Porto, Portugal.
Pediatr Surg Int. 2025 Jun 19;41(1):179. doi: 10.1007/s00383-025-06070-2.
Post-operative management for anorectal malformations (ARM) following surgical repair traditionally includes routine anal dilations (AD) to prevent anal strictures. Recent evidence questions its necessity and highlights psychological distress in patients and parents. We aimed to evaluate dilations' psychosocial impact on both children and caregivers.
Telephone questionnaire was performed to parents of ARM patients who underwent repair between 2009-2023, assessing their perceptions on AD and its' child impact. Patient demographics, ARM classification, AD timing, and post-operative complications were collected.
Thirty-two caregivers participated. Median age at surgery was 5 months; at survey, 10.5 years. ARM with perineal fistula was the most common subtype. AD were performed preoperatively in 21.9%. Post-op, 15,6% did weekly calibrations, 62,5% daily AD. One-quarter of dilations/calibrations were performed by a surgeon in parents' presence, of whom 62.5% reported emotional distress, 75% perception of child discomfort. Home-based AD parents reported difficulty in 54.2%, with two-thirds needing assistance, describing it as distressing for both themselves and their children. Overall, 28.1% perceived a negative psychological impact.
Our findings highlight the significant psychological burden associated with AD. Given increasing evidence of its lack of benefit and psychological impact, our results support a careful re-evaluation of AD routine use.
传统上，肛门直肠畸形（ARM）手术修复后的术后管理包括常规肛门扩张（AD）以预防肛门狭窄。最近的证据对其必要性提出质疑，并强调了患者及其父母的心理困扰。我们旨在评估扩张对儿童及其照顾者的心理社会影响。
对2009年至2023年间接受修复手术的ARM患者的父母进行电话问卷调查，评估他们对AD及其对孩子影响的看法。收集患者人口统计学资料、ARM分类、AD时间和术后并发症。
32名照顾者参与。手术时的中位年龄为5个月；调查时为10.5岁。会阴瘘型ARM是最常见的亚型。21.9%的患者在术前进行了AD。术后，15.6%的患者每周进行扩肛，62.5%的患者每天进行AD。四分之一的扩张/扩肛是在父母在场的情况下由外科医生进行的，其中62.5%的人报告有情绪困扰，75%的人认为孩子不舒服。在家进行AD的父母中有54.2%报告有困难，三分之二的人需要帮助，他们表示这对自己和孩子来说都很痛苦。总体而言，28.1%的人认为有负面心理影响。
我们的研究结果突出了与AD相关的重大心理负担。鉴于越来越多的证据表明其缺乏益处和心理影响，我们的结果支持对AD的常规使用进行仔细重新评估。
