Global Strategies for Postoperative Care and Bowel Management in Patients With Anorectal Malformations: Varied Practices and Barriers.
Document Type
Article
Publication Date
12-2024
Identifier
DOI: 10.1016/j.jpedsurg.2024.161697
Abstract
BACKGROUND: Anorectal malformations (ARMs) commonly result in constipation and fecal incontinence following primary surgical reconstruction. This study investigates global variations in postoperative care and resources.
METHODS: A survey was distributed via the International Pediatric Endosurgery Group (IPEG) and snowball sampling. Geographically, respondents were categorized into high-income countries (HICs) and low-or middle-income countries (LMICs).
RESULTS: 233 surveys were received, 64% from LMICs and 36% from HICs. Of these, 51% reported monitoring ARM patients for over a year, while 23% utilized digital technologies. Access to anesthesia for anorectal exams was available to 70% of respondents. Only 29% had established a one-week Bowel Management Program (BMP). Collaboration with urologists and gynecologists was more prevalent in HICs (59%) compared to LMICs (37%, p < 0.01). In HICs, nurses and advanced practice providers were significantly more involved in BMP (71% vs. 39% in LMICs; p < 0.01), and abdominal radiographs for regimen adjustments were used more frequently (80% vs. 69% in LMICs; p = 0.03). Treatment regimens were more varied in HICs, and quality of life tracking was more consistent (19% vs. 9% in LMICs; p = 0.02). LMICs reported significant shortages of medications and equipment (75% vs. 58% in HICs; p = 0.01), inadequate sanitation (48% vs. 24%; p < 0.01), and insufficient insurance coverage (58% vs. 44%; p = 0.04).
CONCLUSIONS: There are notable global disparities in the postoperative care of ARM patients, particularly in BMP protocols and treatment regimens, with LMICs facing severe socioeconomic challenges. This emphasizes the urgent need for targeted strategies and resources to enhance outcomes for ARM patients across different regions.
LEVEL OF EVIDENCE: Level III.
Journal Title
Journal of pediatric surgery
Volume
59
Issue
12
First Page
161697
Last Page
161697
MeSH Keywords
Humans; Anorectal Malformations; Postoperative Care; Developing Countries; Fecal Incontinence; Global Health; Developed Countries; Health Services Accessibility; Health Care Surveys; Practice Patterns, Physicians'; Postoperative Complications; Anus, Imperforate; Quality of Life; Health Resources
Keywords
Anorectal malformation; Bowel management; Developing countries; Low- and middle-income countries; Postoperative management
Recommended Citation
Bokova E, Elhalaby I, Svetanoff WJ, et al. Global Strategies for Postoperative Care and Bowel Management in Patients With Anorectal Malformations: Varied Practices and Barriers. J Pediatr Surg. 2024;59(12):161697. doi:10.1016/j.jpedsurg.2024.161697
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