Louise Tofft1,2, Martin Salö3,4, Einar Arnbjörnsson3,4, Pernilla Stenström3,4. 1. Department of Pediatric Surgery, Skåne University Hospital, Lasarettsgatan 48, S-221 85, Lund, Sweden. louise.tofft@med.lu.se. 2. Department of Clinical Sciences, Pediatrics, Lund University, Lasarettsgatan 48, S-221 85, Lund, Sweden. louise.tofft@med.lu.se. 3. Department of Pediatric Surgery, Skåne University Hospital, Lasarettsgatan 48, S-221 85, Lund, Sweden. 4. Department of Clinical Sciences, Pediatrics, Lund University, Lasarettsgatan 48, S-221 85, Lund, Sweden.
Abstract
BACKGROUND: Surgical safety during posterior sagittal anorectal plasty (PSARP) for anorectal malformations (ARM) depends on accurate pre-operative fistula localization. This study aimed to evaluate accuracy of pre-operative fistula diagnostics. METHODS: Ethical approval was obtained. Diagnostic accuracy of pre-PSARP symptoms (stool in urine, urine in passive ostomy, urinary tract infection) and examination modalities (voiding cystourethrogram (VCUG), high-pressure colostogram, cystoscopy and ostomy endoscopy) were compared to final intra-operative ARM-type classification in all male neonates born with ARM without a perineal fistula treated at a tertiary pediatric surgery center during 2001-2020. RESULTS: The 38 included neonates underwent reconstruction surgery through PSARP with diverted ostomy. Thirty-one (82%) had a recto-urinary tract fistula and seven (18%) no fistula. Ostomy endoscopy yielded the highest diagnostic accuracy for fistula presence (22 correctly classified/24 examined cases; 92%), and pre-operative symptoms the lowest (21/38; 55%). For pre-operative fistula level determination, cystoscopy yielded the highest diagnostic accuracy (14/20; 70%), followed by colostogram (23/35; 66%), and VCUG (21/36; 58%). No modality proved to be statistically superior to any other. CONCLUSIONS: Ostomy endoscopy has the highest diagnostic accuracy for fistula presence, and cystoscopy and high-pressure colostogram for fistula level determination. Correct pre-operative ARM-typing reached a maximum of 60-70%.
BACKGROUND: Surgical safety during posterior sagittal anorectal plasty (PSARP) for anorectal malformations (ARM) depends on accurate pre-operative fistula localization. This study aimed to evaluate accuracy of pre-operative fistula diagnostics. METHODS: Ethical approval was obtained. Diagnostic accuracy of pre-PSARP symptoms (stool in urine, urine in passive ostomy, urinary tract infection) and examination modalities (voiding cystourethrogram (VCUG), high-pressure colostogram, cystoscopy and ostomy endoscopy) were compared to final intra-operative ARM-type classification in all male neonates born with ARM without a perineal fistula treated at a tertiary pediatric surgery center during 2001-2020. RESULTS: The 38 included neonates underwent reconstruction surgery through PSARP with diverted ostomy. Thirty-one (82%) had a recto-urinary tract fistula and seven (18%) no fistula. Ostomy endoscopy yielded the highest diagnostic accuracy for fistula presence (22 correctly classified/24 examined cases; 92%), and pre-operative symptoms the lowest (21/38; 55%). For pre-operative fistula level determination, cystoscopy yielded the highest diagnostic accuracy (14/20; 70%), followed by colostogram (23/35; 66%), and VCUG (21/36; 58%). No modality proved to be statistically superior to any other. CONCLUSIONS: Ostomy endoscopy has the highest diagnostic accuracy for fistula presence, and cystoscopy and high-pressure colostogram for fistula level determination. Correct pre-operative ARM-typing reached a maximum of 60-70%.
Authors: Pernilla Stenström; Christina Clementson Kockum; Despina Katsianikou Benér; Camilla Ivarsson; Einar Arnbjörnsson Journal: Int J Adolesc Med Health Date: 2014
Authors: Alexander Holschneider; John Hutson; Albert Peña; Elhamy Beket; Subir Chatterjee; Arnold Coran; Michael Davies; Keith Georgeson; Jay Grosfeld; Devendra Gupta; Naomi Iwai; Dieter Kluth; Giuseppe Martucciello; Samuel Moore; Risto Rintala; E Durham Smith; D V Sripathi; Douglas Stephens; Sudipta Sen; Benno Ure; Sabine Grasshoff; Thomas Boemers; Feilin Murphy; Yunus Söylet; Martin Dübbers; Marc Kunst Journal: J Pediatr Surg Date: 2005-10 Impact factor: 2.545
Authors: H J J van der Steeg; E Schmiedeke; P Bagolan; P Broens; B Demirogullari; A Garcia-Vazquez; S Grasshoff-Derr; M Lacher; E Leva; I Makedonsky; C E J Sloots; N Schwarzer; D Aminoff; M Schipper; E Jenetzky; I A L M van Rooij; S Giuliani; C Crétolle; S Holland Cunz; P Midrio; I de Blaauw Journal: Tech Coloproctol Date: 2015-01-22 Impact factor: 3.781