Eur J Pediatr Surg
DOI: 10.1055/s-0038-1632392
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Role of Routine Dilatations after Anorectal Reconstruction—Comparison of Two Tertiary Centers

Dhanya Mullassery
Department of Paediatric Surgery, Great Ormond Street Hospital, London, United Kingdom
,
Sumita Chhabra
Department of Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
,
Ashik Muhamed Babu
Department of Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
,
Roberta Iacona
Department of Paediatric Surgery, Great Ormond Street Hospital For Children NHS Trust, London, United Kingdom
,
Simon Blackburn
Department of Paediatric Surgery, Great Ormond Street Hospital For Children NHS Trust, London, United Kingdom
,
Kate M. Cross
Department of Surgery, Great Ormond Street Hospital for Children, London, United Kingdom
,
Paolo Decoppi
Department of Paediatric Surgery, Great Ormond Street Hospital For Children NHS Trust, London, United Kingdom
,
Colin Tennant Baillie
Department of Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
,
Simon Kenny
Department of Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom
,
Joe I. Curry
Department of Surgery, Great Ormond Street Hospital for Children, London, United Kingdom
› Author Affiliations
Further Information

Publication History

17 September 2017

16 January 2018

Publication Date:
28 February 2018 (eFirst)

Abstract

Aim Regular anal dilatations are commonly recommended in the postoperative management following posterior sagittal anorectoplasty (PSARP) in anorectal malformations (ARM). We hypothesized that routine postoperative dilatations may not affect surgical outcomes following PSARP. We compare surgical outcomes of routine postoperative dilatations versus no routine postoperative dilatations from two United Kingdom tertiary pediatric surgical centers.

Methods This is retrospective records review of patients undergoing definitive surgery for ARM in two tertiary surgical centers in the UK over 5 years. Center A used a protocol of routine postoperative dilatations, and center B used a protocol, which used dilatations only for clinical indications of stricture. Data collected included ARM type, operative procedures, and postoperative interventions. All post-operative interventions under general anesthesia (GA) were compared between groups.

Results From 2011 to 2015, 49 procedures (46 PSARPs) were performed in center A and 54 (52 PSARPs) in center B. Median follow up period was 31 months (interquartile range [IQR] 18–48). The first postoperative anal calibration under GA was documented for 43 (86%) patients in center A and for 42 (78%) patients in center B. Following this, center A followed routine postoperative dilatation (RPD) at home, and center B reserved further dilatations for specific indications. RPD was performed for 100% of patients in center A versus 8% in center B. Further anal dilatations under GA were performed in 19 (38%) children in center A and in 17 (34%) children in center B (p = 0.68). In center A, 10 patients (22%) needed further surgery versus 14 (28%) in center B (p = 0.48).

Conclusion The use of routine postoperative dilatations does not significantly improve surgical outcomes following PSARP in ARM.