Can Anorectal Stenosis be Managed With Dilations Alone? A PCPLC Review

Zoe M Saenz; Kelly Austin; Jeffrey R Avansino; Andrea Badillo; Casey M Calkins; Megan M Durham; Megan K Fuller; Ankur Rana; Ron W Reeder; Rebecca M Rentea; Michael D Rollins; K Elizabeth Speck; Richard J Wood; Jamie C Harris; Jamie Anderson; Maheen Hassan; Payam Saadai; Pediatric Colorectal and Pelvic Learning Consortium (PCPLC)

doi:10.1016/j.jpedsurg.2024.04.007

Can Anorectal Stenosis be Managed With Dilations Alone? A PCPLC Review

J Pediatr Surg. 2024 Apr 20:S0022-3468(24)00258-6. doi: 10.1016/j.jpedsurg.2024.04.007. Online ahead of print.

Authors

Zoe M Saenz¹, Kelly Austin², Jeffrey R Avansino³, Andrea Badillo⁴, Casey M Calkins⁵, Megan M Durham⁶, Megan K Fuller⁷, Ankur Rana⁸, Ron W Reeder⁹, Rebecca M Rentea¹⁰, Michael D Rollins¹¹, K Elizabeth Speck¹², Richard J Wood¹³, Jamie C Harris¹⁴, Jamie Anderson¹, Maheen Hassan¹, Payam Saadai¹⁵; Pediatric Colorectal and Pelvic Learning Consortium (PCPLC)

Affiliations

¹ Department of Surgery, UC Davis Children's Hospital, University of California Davis, Sacramento, CA, USA; Department of Surgery, Shriners Hospital for Children-Northern California, Sacramento, CA, USA.
² Department of Surgery, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, USA.
³ Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA.
⁴ Division of Colorectal and Pelvic Reconstruction, Children's National Hospital, George Washington University, Washington, DC, USA.
⁵ Department of Surgery, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA.
⁶ Department of Surgery, Emory + Childrens Pediatric Institute Atlanta, GA, USA.
⁷ Department of Surgery, Boys Town National Research Hospital, University of Nebraska Medical Center, Boys Town, NE, USA.
⁸ Department of Surgery and Perioperative Care, Dell Children's Medical Center, University of Texas Austin, Austin, TX, USA.
⁹ Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
¹⁰ Department of Surgery, Children's Mercy Hospital, University of Missouri-Kansas City, Kansas City, MO, USA.
¹¹ Department of Surgery, Primary Children's Hospital, University of Utah, Salt Lake City, UT, USA.
¹² Division of Pediatric Surgery, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.
¹³ Department of Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, USA.
¹⁴ Department of Surgery, Phoenix Children's Hospital, University of Arizona, Phoenix, AZ, USA.
¹⁵ Department of Surgery, UC Davis Children's Hospital, University of California Davis, Sacramento, CA, USA; Department of Surgery, Shriners Hospital for Children-Northern California, Sacramento, CA, USA. Electronic address: psaadai@ucdavis.edu.

PMID: 38735806
DOI: 10.1016/j.jpedsurg.2024.04.007

Abstract

Purpose: Congenital anorectal stenosis is managed by dilations or operative repair. Recent studies now propose use of dilations as the primary treatment modality to potentially defer or eliminate the need for surgical repair. We aim to characterize the management and outcomes of these patients via a multi-institutional review using the Pediatric Colorectal and Pelvic Learning Consortium (PCPLC) registry.

Methods: A retrospective database review was performed using the PCPLC registry. The patients were evaluated for demographics, co-morbidities, diagnostic work-up, surgical intervention, current bowel management, and complications.

Results: 64 patients with anal or rectal stenosis were identified (57 anal, 7 rectal) from a total of 14 hospital centers. 59.6% (anal) and 42.9% (rectal) were male. The median age was 3.2 (anal) and 1.9 years (rectal). 11 patients with anal stenosis also had Currarino Syndrome with 10 of the 11 patients diagnosed with a presacral mass compared to only one rectal stenosis with Currarino Syndrome and a presacral mass. 13 patients (22.8%, anal) and one (14.3%, rectal) underwent surgical correction. Nine patients (8 anal, 1 rectal) underwent PSARP. Other procedures performed were cutback anoplasty and anterior anorectoplasty. The median age at repair was 8.4 months (anal) and 10 days old (rectal). One patient had a wound complication in the anal stenosis group. Bowel management at last visit showed little differences between groups or treatment approach.

Conclusion: The PCPLC registry demonstrated that these patients can often be managed successfully with dilations alone. PSARP is the most common surgical repair chosen for those who undergo surgical repair.

Level of evidence: III.

Keywords: Anorectal malformation; Congenital anal stenosis; Congenital rectal stenosis; Currarino; Dilations; Presacral mass; Surgery.