Single-stage procedures for anorectal malformations: A systematic review and meta-analysis

Leila Hartford; Giulia Brisighelli; Tarryn Gabler; Chris Westgarth-Taylor

doi:10.1016/j.jpedsurg.2021.12.024

Single-stage procedures for anorectal malformations: A systematic review and meta-analysis

J Pediatr Surg. 2022 Sep;57(9):75-84. doi: 10.1016/j.jpedsurg.2021.12.024. Epub 2022 Jan 7.

Authors

Leila Hartford¹, Giulia Brisighelli², Tarryn Gabler², Chris Westgarth-Taylor²

Affiliations

¹ Pediatric Colorectal and Pelvic Reconstruction Centre, Department of Pediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa. Electronic address: leilahartford@gmail.com.
² Pediatric Colorectal and Pelvic Reconstruction Centre, Department of Pediatric Surgery, Chris Hani Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa.

PMID: 35063254
DOI: 10.1016/j.jpedsurg.2021.12.024

Abstract

Background: The purpose of this study is to describe all published studies of single-stage procedures for anorectal malformations and to perform a meta-analysis of studies that compared single-stage to staged procedures.

Methods: Searches were conducted in Pubmed, Medline, Embase and CENTRAL. Meta-analysis was performed in RevMan and expressed as forest plots with odds ratios (OR) and 95% confidence intervals (CI).

Results: Thirty-eight studies were included in the narrative synthesis. Nine studies were included in the meta-analysis, representing 537 patients. The majority (70%) of patients included in this meta-analysis had either perineal or vestibular fistulas. Surgical site infection (SSI) was defined as any reported infection involving the neoanus (both superficial infection and dehiscence) and occurred in 51 of the 291 patients who underwent single-stage procedures, and 26 of the 244 patients who underwent staged procedure. Meta-analysis showed a 2.2 times higher risk of surgical site infection (SSI) amongst patients who undergo single-stage procedures (OR 2.22, 95% CI 1.26, 3.92). Six of the 293 patients (2%) who underwent single-stage procedures required a rescue ostomy for wound dehiscence. In LMIC the risk of wound dehiscence was three-fold higher in single-stage (36/202) compared to staged procedures (12/126) (OR 3.07, 95% CI 1.42, 6.63). In HIC there was no evidence of an increased risk of wound dehiscence in patients who underwent a single-stage (15/91) compared to a staged procedure (14/118) (OR 1.51, 95% CI 0.65, 3.51). There is no evidence of a difference between single-stage versus staged procedures with regards to functional outcomes including voluntary bowel movements (79/90 versus 111/128), soiling (24/165 versus 20/203) or constipation (27/90 versus 36/128).

Conclusion: This systematic review provides further evidence that single-stage procedures for selected patients with anorectal malformations are safe. Whilst there is evidence of an increased risk of SSI, this did not translate to a significant difference in long-term functional outcomes.

Levels of evidence: Level II.

Keywords: Anorectal malformations; Colostomy; Primary PSARP; Single-stage.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Anorectal Malformations* / complications
Anorectal Malformations* / surgery
Constipation / etiology
Humans
Perineum
Rectal Fistula* / surgery
Surgical Wound Infection / complications
Surgical Wound Infection / etiology