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Treatment of megarectum in anorectal malformation with emphasis on preventive aspects: 17 years experience

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Abstract

Purpose

Megarectum in anorectal malformation (ARM) causes severe morbidity. To compare conservative management (CM) of megarectum with excision (EX), to propose a new classification and to analyse management strategies.

Methods

Between 2000–2016, we reviewed all ARM to identify megarectum, defined by radiological recto-pelvic ratio > 0.61. A new classification was proposed: primary megarectum (PM) pre-anorectoplasty, and secondary megarectum (SM) post-anorectoplasty, with sub-types. Complications and Krickenbeck bowel function were compared between CM and EX.

Results

Of 124 ARM, 22 (18%) developed megarectum; of these, 7 underwent EX. There was no difference in functional outcomes when comparing CM vs EX—voluntary bowel movement (both 86%), soiling (40% vs. 57%) and constipation (both 86%). However, EX was associated with major complications (43%) and the requirement for invasive bowel management, compared to CM (85% vs. 27%, P = 0.02). 6/7 EX needed antegrade continence enema (ACE), one of these has a permanent ileostomy. With strategic changes, incidence of megarectum reduced from 20/77 (26%) to 2/47 (4%) after 2013 (P = 0.002).

Conclusion

EX did not confer benefit in the functional outcome but carried a high risk of complications, often needing ACE or stoma. By adhering to strategies discussed, we reduced the incidence of megarectum and have avoided EX since 2013.

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Abbreviations

ACE:

Antegrade continence enema

ARM:

Anorectal malformation

ARP:

Ano-rectoplasty

CM:

Conservative management

EX:

Excision of megarectum

FU:

Follow-up

ISSA:

Internal sphincter-sparing ano-rectoplasty

PM:

Primary megarectum

PSARP:

Posterior sagittal ano-rectoplasty

SCT:

Sacrococcygeal teratoma

SM:

Secondary megarectum

TAI:

Transanal irrigation

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Authors and Affiliations

  1. Department of Paediatric Surgery, The Royal London Hospital, Whitechapel, London, E1 1BB, UK

    Yew-Wei Tan, Kyla Ng Yin, Anne Yan Ting Chua, Stewart Cleeve & Devesh Misra

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  1. Yew-Wei Tan
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  2. Kyla Ng Yin
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Correspondence to Devesh Misra.

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Tan, YW., Yin, K.N., Chua, A.Y.T. et al. Treatment of megarectum in anorectal malformation with emphasis on preventive aspects: 17 years experience. Pediatr Surg Int 36, 933–940 (2020). https://doi.org/10.1007/s00383-020-04687-z

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