Can fecal continence be predicted in patients born with anorectal malformations?

被引:28
|
作者
Minneci, Peter C. [1 ,2 ]
Kabre, Rashmi S. [3 ]
Mak, Grace Z. [4 ]
Halleran, Devin R. [1 ,2 ]
Cooper, Jennifer N. [1 ,2 ]
Afrazi, Amin [5 ]
Calkins, Casey M. [6 ]
Corkum, Kristine [3 ]
Downard, Cynthia D. [7 ]
Ehrlich, Peter [8 ]
Fraser, Jason D. [9 ]
Gadepalli, Samir K. [8 ]
Helmrath, Michael A. [10 ]
Kohler, Jonathan E. [5 ]
Landisch, Rachel [6 ]
Landman, Matthew P. [11 ]
Lee, Constance [12 ]
Leys, Charles M. [5 ]
Lodwick, Daniel L. [1 ,2 ]
McLeod, Jennifer [8 ]
Mon, Rodrigo [8 ]
McClure, Beth [7 ]
Rymeski, Beth [10 ]
Saito, Jacqueline M. [12 ]
Sato, Thomas T. [6 ]
St Peter, Shawn D. [9 ]
Wood, Richard [1 ,2 ]
Levitt, Marc A. [1 ,2 ]
Deans, Katherine J. [1 ,2 ]
机构
[1] Nationwide Childrens Hosp, Dept Pediat Surg, Columbus, OH USA
[2] Nationwide Childrens Hosp, Res Inst, Columbus, OH USA
[3] Northwestern Univ, Ann & Robert H Lurie Childrens Hosp Chicago, Feinberg Sch Med, Div Pediat Surg,Dept Surg, Chicago, IL 60611 USA
[4] Univ Chicago Med & Biol Sci, Dept Surg, Sect Pediat Surg, Chicago, IL USA
[5] Univ Wisconsin, Dept Surg, Div Pediat Surg, Madison, WI USA
[6] Med Coll Wisconsin, Dept Surg, Div Pediat Surg, 8700 W Wisconsin Ave, Milwaukee, WI 53226 USA
[7] Univ Louisville, Hiram C Polk Jr MD Dept Surg, Div Pediat Surg, Louisville, KY 40292 USA
[8] Univ Michigan, Dept Surg, Sect Pediat Surg, Ann Arbor, MI 48109 USA
[9] Childrens Mercy Hosp, Dept Surg, Div Pediat Surg, Kansas City, MO 64108 USA
[10] Cincinnati Childrens Hosp Med Ctr, Div Pediat Surg, Cincinnati, OH 45229 USA
[11] Indiana Univ Sch Med, Dept Surg, Div Pediat Surg, Indianapolis, IN 46202 USA
[12] Washington Univ, Sch Med, Dept Surg, Div Pediat Surg, St Louis, MO 63110 USA
关键词
Anorectal malformation; Continence; Predictors; Spine; Sacral ratio; QUALITY-OF-LIFE; BOWEL MANAGEMENT; INCONTINENCE; CHILDREN; EMBRYOLOGY; CORD;
D O I
10.1016/j.jpedsurg.2019.02.035
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Purpose: The purpose of this study was to identify factors associated with attaining fecal continence in children with anorectal malformations (ARM). Methods: We performed a multi-institutional cohort study of children born with ARM in 2007-2011 who had spinal and sacral imaging. Questions from the Baylor Social Continence Scale were used to assess fecal continence at the age of years. Factors present at birth that predicted continence were identified using multivariable logistic regression. Results: Among 144 ARM patients with a median age of 7 years (IQR 6-8), 58 (40%) were continent. The rate of fecal continence varied by ARM subtype (p = 0.002) with the highest rate of continence in patients with perineal fistula (60%). Spinal anomalies and the lateral sacral ratio were not associated with continence. On multivariable analysis, patients with less severe ARM subtypes (perineal fistula, recto-bulbar fistula, recto-vestibular fistula, no fistula, rectal stenosis) were more likely to be continent (OR 7.4, p = 0.001). Conclusion: Type of ARM was the only factor that predicted fecal continence in children with ARM. The high degree of incontinence, even in the least severe subtypes, highlights that predicting fecal continence is difficult at birth and supports the need for long-term follow-up and bowel management programs for children with ARM. Type of Study: Prospective Cohort Study. (C) 2019 Elsevier Inc. All rights reserved.
引用
收藏
页码:1159 / 1163
页数:5
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