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01-02-2019 | Original Article

Impact of the associated anorectal malformation on the outcome of spinal dysraphism after untethering surgery

Authors: Giorgia Totonelli, Raffaella Messina, Francesco Morini, Giovanni Mosiello, Chiara Iacusso, Franco Randi, Paolo Palma, Pietro Bagolan, Barbara Daniela Iacobelli

Published in: Pediatric Surgery International | Issue 2/2019

Abstract

Purpose

To analyze the outcome after untethering surgery in patients with spinal dysraphism (SD), with or without associated anorectal malformation (ARM).

Methods

Patients operated on for SD, with (Group A) or without (Group B) associated ARM (1999–2015), were included. The post-operative outcome was analyzed in the two groups in terms of improving of clinical symptoms (neuro-motor deficits, bladder dysfunction, bowel dysfunction) and of instrumental examinations (urodynamics, bladder ultrasound, neurophysiology). Fisher’s exact test and χ² test were used as appropriate; p < 0.05 was considered statistically significant.

Main results

Ten patients in Group A and 24 in Group B were consecutively treated. One patient was lost at follow up. Six patients (25%) in Group B underwent prophylactic surgery. The analysis of the pre-operative symptoms in the two groups showed that a significantly higher number of patients in group A needed bowel management and presented with neuro-motor deficits, compared to group B (p = 0.0035 and p = 0.04, respectively). Group A showed a significant post-operative neuro-motor improvement as compared to group B (p = 0.002).

Conclusions

Based on our results, untethering seems to be effective in neuro-motor symptoms in selected patients with ARM. In ARM patients, untethering surgery does not seem to benefit intestinal and urinary symptoms. The presence of the associated ARM does not seem to impact the medium-term outcome of patients operated for SD.

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Title: Impact of the associated anorectal malformation on the outcome of spinal dysraphism after untethering surgery
Authors: Giorgia Totonelli
Raffaella Messina
Francesco Morini
Giovanni Mosiello
Chiara Iacusso
Franco Randi
Paolo Palma
Pietro Bagolan
Barbara Daniela Iacobelli
Publication date: 01-02-2019
Publisher: Springer Berlin Heidelberg
Published in: Pediatric Surgery International / Issue 2/2019
Print ISSN: 0179-0358
Electronic ISSN: 1437-9813
DOI: https://doi.org/10.1007/s00383-018-4400-8

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Impact of the associated anorectal malformation on the outcome of spinal dysraphism after untethering surgery

Abstract

Purpose

Methods

Main results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Main results

Conclusions

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