Accuracy of pre-operative fistula diagnostics in anorectal malformations

Background Surgical safety during posterior sagittal anorectal plasty (PSARP) for anorectal malformations (ARM) depends on accurate pre-operative fistula localization. This study aimed to evaluate accuracy of pre-operative fistula diagnostics. Methods Ethical approval was obtained. Diagnostic accura...

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Published inBMC pediatrics Vol. 21; no. 1; pp. 1 - 283
Main Authors Tofft, Louise, Salö, Martin, Arnbjörnsson, Einar, Stenström, Pernilla
Format Journal Article
LanguageEnglish
Published London BioMed Central Ltd 16.06.2021
BioMed Central
BMC
Subjects
Abnormalities
Accuracy
Anorectal malformations
Catheters
Classification
Clinical Medicine
Colostogram
Cystoscopy
Diagnosis
Endoscopy
Fistula
Gastrointestinal system
Intubation
Klinisk medicin
Medical and Health Sciences
Medical diagnosis
Medical records
Medicin och hälsovetenskap
Methods
Ostomy
Patients
Pediatric research
Pediatrics
Pediatrik
Preoperative care
Rectum
Surgery
Urinary tract infections
Urine
Urogenital system
Voiding cystourethrogram
Sweden
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Summary:Background Surgical safety during posterior sagittal anorectal plasty (PSARP) for anorectal malformations (ARM) depends on accurate pre-operative fistula localization. This study aimed to evaluate accuracy of pre-operative fistula diagnostics. Methods Ethical approval was obtained. Diagnostic accuracy of pre-PSARP symptoms (stool in urine, urine in passive ostomy, urinary tract infection) and examination modalities (voiding cystourethrogram (VCUG), high-pressure colostogram, cystoscopy and ostomy endoscopy) were compared to final intra-operative ARM-type classification in all male neonates born with ARM without a perineal fistula treated at a tertiary pediatric surgery center during 2001-2020. Results The 38 included neonates underwent reconstruction surgery through PSARP with diverted ostomy. Thirty-one (82%) had a recto-urinary tract fistula and seven (18%) no fistula. Ostomy endoscopy yielded the highest diagnostic accuracy for fistula presence (22 correctly classified/24 examined cases; 92%), and pre-operative symptoms the lowest (21/38; 55%). For pre-operative fistula level determination, cystoscopy yielded the highest diagnostic accuracy (14/20; 70%), followed by colostogram (23/35; 66%), and VCUG (21/36; 58%). No modality proved to be statistically superior to any other. Conclusions Ostomy endoscopy has the highest diagnostic accuracy for fistula presence, and cystoscopy and high-pressure colostogram for fistula level determination. Correct pre-operative ARM-typing reached a maximum of 60-70%. Keywords: Anorectal malformations, Fistula, Voiding cystourethrogram, Colostogram, Cystoscopy, Endoscopy
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ISSN:1471-2431
1471-2431
DOI:10.1186/s12887-021-02761-6