Screening for VACTERL Anomalies in Children with Anorectal Malformations: Outcomes of a Standardized Approach.

PURPOSE: The majority of patients with an anorectal malformation (ARM) have associated congenital anomalies. It is well established that all patients diagnosed with an ARM should undergo systematic screening, including renal, spinal, and cardiac imaging. This study aimed to evaluate the findings and completeness of screening, following local implementation of standardized protocols. METHODS: A retrospective cohort study was performed assessing all patients with an ARM managed at our tertiary pediatric surgical center, following a standardized protocol implementation for VACTERL screening (January 2016-December 2021). Cohort demographics, medical characteristics, and screening investigations were analyzed. Findings were compared with our previously published data (2000-2015), conducted prior to protocol implementation. RESULTS: One hundred twenty-seven (64 male, 50.4%) children were eligible for inclusion. Complete screening was performed in 107/127 (84.3%) children. Of these, one or more associated anomalies were diagnosed in 85/107 (79.4%), whilst the VACTERL association was demonstrated in 57/107 (53.3%). The proportion of children that underwent complete screening increased significantly in comparison with those assessed prior to protocol implementation (RR 0.43 [CI 0.27-0.66]; p < 0.001). Children with less complex ARM types were significantly less likely to receive complete screening (p = 0.028). Neither presence of an associated anomaly, nor prevalence of the VACTERL association, differed significantly by ARM type complexity. CONCLUSION: Screening for associated VACTERL anomalies in children with ARM was significantly improved following standardized protocol implementation. The prevalence of associated anomalies in our cohort supports the value of routine VACTERL screening in all children with ARM, regardless of malformation type. LEVEL OF EVIDENCE: II.

Comparison of inconclusive rates between suction rectal biopsy and open strip rectal biopsy in children of different age groups: a single-center retrospective study.

Background: Rectal biopsy for the diagnosis for Hirschsprung's disease (HD) can be performed in several ways. Suction rectal biopsy (SRB) is the most widely used method for neonates and younger infants while open strip biopsy (OSB) is reserved for older children. Current notions suggest that SRB should not be used in older infants due to perceived thicker fibrous tissue in their rectal walls leading to higher rates of inconclusive results. This study aims to compare the inconclusive rates of both methods in children of different age groups. Methods: A retrospective study were carried out with patients aged 13 years who underwent SRB or OSB during a 4-year period in a single center. Rectal biopsies were performed on patients with HD with previous endorectal pull-through surgeries excluded. Primary outcomes were rates of inconclusive results for SRB and OSB overall and when divided into different age groups. Results: 79 biopsies (57 SRB and 22 OSB) were included in the study. 12 biopsies (9 SRB and 3 OSB) were deemed inconclusive. There was no significant difference in the rate of inconclusive results between patients underwent SRB and OSB overall (15.8% vs 13.6%, p=1.000). The same results were obtained when patients were divided into under one year and over one year groups or other different age groups (30.0% vs 33.3%, p=1.000). Conclusions: Despite low biopsy numbers, our study suggests that SRB provides comparable rates of inconclusive results with OSB in children of all age groups.

Documented complications of staple hemorrhoidopexy: a systematic review.

A systematic review addressing reported complications of stapled hemorrhoidopexy was conducted. Articles were identified via searching OVID and MEDLINE between July 2011 and October 2013. Limitations were placed on the search criteria with articles published from 1998 to 2013 being included in this review. No language restrictions were placed on the search, however foreign language articles were not translated. Two reviewers independently screened the abstracts for relevance and their suitability for inclusion. Data extraction was conducted by both reviewers and entered and analyzed in Microsoft Excel. The search identified 784 articles and 78 of these were suitable for inclusion in the review. A total of 14,232 patients underwent a stapled hemorrhoidopexy in this review. Overall complication rates of stapled hemorrhoidopexy ranged from 3.3%-81% with 5 mortalities documented. Early and late complications were defined individually with overall data suggesting that early complications ranged from 2.3%-58.9% and late complications ranged from 2.5%-80%. Complications unique to the procedure were identified and rates recorded. Both early and late complications unique to stapled hemorrhoidopexy were identified and assessed.

An exploration of the perceptions of male partners involved in the birthing experience at a regional Australian hospital.

INTRODUCTION: The benefits to women of having their male partners present during labor and birth have been well documented, but the effects on men of sharing the birth experience have been less well explored. Several studies have suggested that male partners' positive experiences at this time may benefit partner and family relationships subsequently, whereas negative experiences may translate into later difficulties in these relationships. This study explored the perceptions of male partners involved in the birthing experience in the Integrated Women's Health Unit of Cairns Base Hospital, Cairns, Australia, over a 6-month period in 2010. The aims of the study were to document male partners' self-reported perceptions of their antenatal, labor, and birth experiences and birth expectations and birth involvement and to determine whether these perceptions influenced their feelings that their presence during birth was beneficial to the birthing woman. METHODS: Participants were men experiencing for the first time their partner giving birth. A self-administered 14-item questionnaire was used to collect data; 163 of 200 eligible participants returned completed questionnaires. Continuous variables were converted to categorical variables and chi-square testing was used to determine significant differences between groups. The relationship between beneficial presence and antenatal, labor, and birthing experiences was assessed using correlation analysis and hierarchical regression analysis. RESULTS: There was a significant relationship demonstrated between perceived benefit of the partners' presence and positive perception of both antenatal experience and birth involvement. There also was a positive relationship between realized birth expectations and both antenatal experience and birth involvement. DISCUSSION: This study suggests that male partners' perceptions of beneficial presence during the birth experience can be enhanced by their feeling well informed and supported during the antenatal period and feeling involved and supported by staff during birth. These findings have implications for the provision of information and support to male partners by midwives and childbirth educators and provide the basis for further research in this area.