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BMC Pediatrics

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Open Access 01-12-2021 | Endoscopy | Research

Accuracy of pre-operative fistula diagnostics in anorectal malformations

Authors: Louise Tofft, Martin Salö, Einar Arnbjörnsson, Pernilla Stenström

Published in: BMC Pediatrics | Issue 1/2021

Abstract

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%.

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Title: Accuracy of pre-operative fistula diagnostics in anorectal malformations
Authors: Louise Tofft
Martin Salö
Einar Arnbjörnsson
Pernilla Stenström
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Endoscopy
Posterior Sagittal Anorectoplasty
Urinary Tract Infection
Published in: BMC Pediatrics / Issue 1/2021
Electronic ISSN: 1471-2431
DOI: https://doi.org/10.1186/s12887-021-02761-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Accuracy of pre-operative fistula diagnostics in anorectal malformations

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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