Multi-Institutional Review From the Pediatric Colorectal and Pelvic Learning Consortium of Minor Spinal Cord Dysraphism in the Setting of Anorectal Malformations: Diagnosis, Treatment, and Outcomes.
Document Type
Article
Publication Date
8-2023
Identifier
DOI: 10.1016/j.jpedsurg.2023.04.009
Abstract
BACKGROUND/RATIONALE: Anorectal malformations (ARM) are associated with congenital anomalies of the spine, but the impact of a minor spinal cord dysraphism (mSCD) on fecal continence in the setting of ARM remains unclear.
MATERIALS/METHODS: A retrospective review was performed utilizing data from the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) registry. The patient cohort was reviewed for ARM type, mSCD screening/incidence/neurosurgical intervention and age-based BMP utilization.
RESULTS: 987 patients with ARM were categorized into mild (38%), moderate (32%) or complex (19%). 694 (70%) had normal spinal (NS) status. 271 (27.5%) patients had mSCD. MRI alone (49%) was the most common screening test for mSCD. US screening had a positive predictive value of 86.3% and a negative predictive value of 67.1%. Surgical intervention rates for mSCD ranged between 13% and 77% at a median age of 0.6-5.2 years. 726 (73.6%) patients were prescribed BMP (74.4% NS, 77.5% mSCD). Laxatives were most utilized BMP in all groups
CONCLUSIONS: MSCD influence on bowel function in the setting ARM remains unclear. No significant impact of mSCD was noted on ARM patient bowel management program utilization. Variability exists within PCPLC site with screening and intervention for mSCD in patients with ARM. Future studies with standardized care may be needed to elucidate the true impact of mSCD on long term patient outcomes in ARM patients.
TYPE OF STUDY: Retrospective Comparative Study.
LEVEL OF EVIDENCE: III.
Journal Title
Journal of pediatric surgery
Volume
58
Issue
8
First Page
1582
Last Page
1587
MeSH Keywords
Child; Humans; Infant; Child, Preschool; Anorectal Malformations; Retrospective Studies; Spinal Dysraphism; Neural Tube Defects; Spinal Cord; Heart Defects, Congenital; Colorectal Neoplasms
Keywords
Anorectal malformation; Bowel management protocols; Spinal cord dysraphism
Recommended Citation
Garvey EM, Fuller M, Frischer J, et al. Multi-Institutional Review From the Pediatric Colorectal and Pelvic Learning Consortium of Minor Spinal Cord Dysraphism in the Setting of Anorectal Malformations: Diagnosis, Treatment, and Outcomes. J Pediatr Surg. 2023;58(8):1582-1587. doi:10.1016/j.jpedsurg.2023.04.009
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