Perineal Groove: An Anorectal Malformation Network, Consortium Study.

OBJECTIVE: To review the Anorectal Malformation Network experience with perineal groove (PG) focusing on its clinical characteristics and management. STUDY DESIGN: Data on patients with PG managed at 10 participating Anorectal Malformation Network centers in 1999-2019 were collected retrospectively by questionnaire. RESULTS: The cohort included 66 patients (65 females) of median age 1.4 months at diagnosis. The leading referral diagnosis was anal fissure (n = 20 [30.3%]): 23 patients (34.8%) had anorectal malformations. Expectant management was practiced in 47 patients (71.2%). Eight (17%) were eventually operated for local complications. The median time to surgery was 14 months (range, 3.0-48.6 months), and the median age at surgery was 18.3 months (range, 4.8-58.0 months). In the 35 patients available for follow-up of the remaining 39 managed expectantly, 23 (65.7%) showed complete or near-complete self-epithelization by a mean age 15.3 months (range, 1-72 months) and 4 (11.4%) showed partial self-epithelization by a mean age 21 months (range, 3-48 months). Eight patients showed no resolution (5 were followed for ≤3 months). Nineteen patients (28.7%) were primarily treated with surgery. In total, 27 patients were operated. Dehiscence occurred in 3 of 27 operated patients (11.1%). CONCLUSIONS: PG seems to be an underestimated anomaly, frequently associated with anorectal malformations. Most cases heal spontaneously; therefore, expectant management is recommended. When associated with anorectal malformations requiring reconstruction, PG should be excised in conjunction with the anorectoplasty.

Underdiagnosis of Mild Congenital Anorectal Malformations.

OBJECTIVE: To determine whether the frequency and severity of congenital anorectal malformations (CARMs) differs by sex. STUDY DESIGN: We included 129 patients (0-319 weeks old) diagnosed with CARMs, who had been referred to our Department of Pediatric Surgery between 2004 and 2013. Rectoperineal and rectovestibular fistulas were classified as mild CARMs, all others as severe. If a patient was diagnosed with CARM within 48 hours after birth, this was considered an early diagnosis, all others as late. RESULTS: Seventy-five (58%) girls and 54 (42%) boys were diagnosed with different forms of CARM. More patients had mild rather than severe forms of CARM (67% and 33%, respectively, P <.001). We found that 89% of girls had a mild form of CARM, whereas 65% of boys had severe forms (P <.001). All severe forms were diagnosed early, whereas 54% mild forms were diagnosed early and 46% were diagnosed late. CONCLUSIONS: Girls more often have mild forms of CARM, whereas boys more often have severe forms. Overall, the distribution across the sexes is equal. Because chronic constipation can be the only symptom of mild CARMs, it often requires more time to diagnose than severe forms. Many women are, therefore, diagnosed with CARMs at an older age, or they may go undiagnosed altogether. Subsequently, these women have a greater risk of full rupture during vaginal delivery.

Características y enfoque terapéutico de pacientes con malformaciones anorrectales en dos Hospitales sampedranos / Clinical characteristics and therapeutic approach of patients with Anorrectal Malformations in two Hospitals of San Pedro Sula

Antecedentes: Las malformaciones anorrec-tales (MAR) se componen de una amplia gama de anormalidades que se asocian con varias patologías. Afectan tanto al sexo masculino como femenino, en algunos casos incluyen al aparato urinario y genital. Objetivo: Describir las características clínicas y el enfoque tera-péutico de pacientes con Malformaciones Anorrectales en dos Hospitales de San Pedro Sula, Honduras, durante los años 2012 al 2016. Pacientes y Métodos: Estudio cuantitativo, descriptivo, transversal, realizado en pacientes con malformación anorrectal del Hospital Nacional Dr. Mario Catarino Rivas y el Hospital de Niños Quemados y Cirugía Pediátrica Ruth Paz. La muestra fueron 94 pacientes, la infor-mación se obtuvo del expediente clínico y se procesó en el software estadístico IBM SPSS 22. Resultados: En cuanto al sexo, 53.2% (n=50) eran mujeres y 46.8% (n=44) hombres, 30.9% (n=29) tenían un año de edad, 51.1% (n=48) provenían del departamento de Cortés. En los hombres, se encontró fístula perineal en 30.2% (n=14) pacientes y en las mujeres se encontró fístula rectovestibular en 37.3% (n=19), se encontró asociación a otro tipo de malformaciones congénitas en 29% (n=27) de los pacientes. El tratamiento consistió en colostomía protectora seguido de Anorrecto-plastía sagital posterior tipo Peña y por último el programa de dilataciones anorrectalesa 59.6% (n=56) y 85.3% no presentó complica-ciones quirúrgicas. Conclusiones: Las mal- formaciones anorrectales en este estudio afec-taron más a las mujeres que a los hombres, la edad que predominó fueron los pacientes de 1 año, procedentes en su mayoría del departa-mento de Cortés, especí camente de San Pedro Sula...(AU)