Abstract
Background Surgical advancements have led to improved outcomes for children with congenital
anorectal malformations with vestibular and perineal fistulas. However, the effect
of perioperative nutritional management is debated and guidelines have not yet been
established.
Objective The study aims to give an overview of available published evidence, regarding the
impact of different perioperative nutritional management protocols on surgical outcome.
Methods A systematic literature review was conducted using PubMed, Embase, Cochrane Library,
and CINAHL databases. All original articles concerning perioperative nutrition in
children with vestibular and perineal fistulas were included. Methodological quality
was assessed with the Rangel score. Included studies were subdivided into two groups:
early enteral nutrition and prolonged fasting with or without parenteral nutrition.
Results The database search resulted in 768 publications. Nine studies were eligible for
inclusion. Wound complications were present in 56 of the 1,557 patients (4%) in whom
this was assessed, and were more frequently seen in the prolonged fasting group (2
vs. 10%, p < 0.0001). Regarding the long-term outcome, constipation (grade II–III) was seen in
4% of the early feeding group, compared with 13% in the prolonged fasting group (p < 0.0001).
Conclusion This systematic review presents an overview of studies reporting on perioperative
nutritional management in children with perineal and vestibular fistulas. Although
study quality is low and study heterogeneity may also influence our results, early
enteral feeding seems to be the preferable postoperative feeding strategy. Both early
wound complications as well as long-term complications, in terms of clinically relevant
constipation, seem to be lower in the early enteral feeding group. However, a prospective
randomized, multicentered trial should be initiated to draw definitive conclusions
regarding this matter.
Keywords
anorectal malformation - perineal fistula - vestibular fistula - parenteral nutrition
