Current management of anorectal malformation in Egypt: a survey of members of the Egyptian pediatric surgical association

Abstract

Background/aim: Anorectal malformation (ARM) represents a wide spectrum of anomalies. Its management includes various strategies. This survey aims at detecting the current preferences of Egyptian pediatric surgeons regarding the management of ARM.

Materials and methods: A survey was circulated individually to the members of the Egyptian Pediatric Surgical Association (EPSA) during the general assembly meeting. Another online survey using web-based surveys (Survey Monkey) was also used.

Results: Responses were received from 91 surgeons. Nine responses were excluded because of incomplete or duplicate responses, yielding 82 survey charts for analysis. The 82 responses represent 74.5% of the 110 fully-trained pediatric surgeons currently working in Egypt. Sixty-one (74.4 %) of responders used invertogram for preoperative diagnosis of ARM. A further seven (8.5%) combined invertogram with perineal ultrasonography or MRI. The remaining 14 (17.1%) used either perineal ultrasonography or MRI. The age at surgery for high ARM was preferred immediately after birth without colostomy by only five (6.1%) of responders, from 1 to 3 months after initial colostomy by 21 (25.61%), 3?6 months after colostomy by 45 (54.88%), and 6 months after colostomy by 11 (13.41%). The preferable definitive surgical technique for high ARM in male is posterior sagittal anorectoplasty according to 63 (76.82%) surgeons, laparoscopic assisted by 15 (18.3%), and abdminoperineal by four (4.88%) The preferable time for primary repair of rectovestibular fistulas was neonatal period for only nine (10.98%) surgeons, from 1 to 3 months for 20 (24.39%), after the third month for life by 40 (48.78%), whereas 13 (15.85%) did not perform single-stage repair. As regard to outcome of primary versus staged repair for rectovestibular fistula, 64.7% of participants stated that primary repair has similar outcomes compared with staged repair, 19.5% stated that staged repair has lesser complications and better outcome, and 15.8% of participants did not perform singlestage repair.

Conclusion: The current EPSA survey indicates that most surgeons still use the invertogram as the principal preoperative diagnostic study. Posterior sagittal anorectoplasty is the preferable definitive surgical technique for high ARM in males. Most surgeons prefer primary repair for rectovestibular fistulas. Laparoscopic approach for the management of high ARM is currently practiced by only a few surgeons.

Keywords: ARM, survey, EPSA