European consensus meeting of ARM-Net members concerning diagnosis and early management of newborns with anorectal malformations

Abstract

The ARM-Net (anorectal malformation network) consortium held a consensus meeting in which the classification of ARM and preoperative workup were evaluated with the aim of improving monitoring of treatment and outcome. The Krickenbeck classification of ARM and preoperative workup suggested by Levitt and Peña, used as a template, were discussed, and a collaborative consensus was achieved. The Krickenbeck classification is appropriate in describing ARM for clinical use. The preoperative workup was slightly modified. In males with a visible fistula, no cross-table lateral X-ray is needed and an anoplasty or (mini-) posterior sagittal anorectoplasty can directly be performed. In females with a small vestibular fistula (Hegar size <5 mm), a primary repair or colostomy is recommended; the repair may be delayed if the fistula admits a Hegar size >5 mm, and in the meantime, gentle painless dilatations can be performed. In both male and female perineal fistula and either a low birth weight (<2,000 g) or severe associated congenital anomalies, prolonged preoperative painless dilatations might be indicated to decrease perioperative morbidity caused by general anesthesia. The Krickenbeck classification is appropriate in describing ARM for clinical use. Some minor modifications to the preoperative workup by Levitt and Peña have been introduced in order to refine terminology and establish a comprehensive preoperative workup.

Comparison of Diagnostic Accuracy for the Low‐Type Imperforate Anus Between Prone Cross‐Table Radiography and Sonography

“…In contrast, a diverting colostomy followed by posterior sagittal anorectoplasty is performed for an intermediate-or high-type imperforate anus. [2][3][4][5] Prone cross-table radiography is currently the most widely used imaging method for classifying an imperforate anus. 4,6,7 Prone cross-table radiography is indicated in cases with no visible fistula, normal buttocks, a normal spine, a normal sacrum, and negative urinalysis results for meconium.…”

“…[2][3][4][5] Prone cross-table radiography is currently the most widely used imaging method for classifying an imperforate anus. 4,6,7 Prone cross-table radiography is indicated in cases with no visible fistula, normal buttocks, a normal spine, a normal sacrum, and negative urinalysis results for meconium. 4 Prone cross-table radiography should be performed 20 to 24 hours after the initial examination to allow time for intraluminal pressure in the rectal pouch to increase.…”

“…4,6,7 Prone cross-table radiography is indicated in cases with no visible fistula, normal buttocks, a normal spine, a normal sacrum, and negative urinalysis results for meconium. 4 Prone cross-table radiography should be performed 20 to 24 hours after the initial examination to allow time for intraluminal pressure in the rectal pouch to increase. 4,7 Previous studies have shown that sonography is useful for classifying the imperforate anus type both by establishing the distance between the distal rectal pouch and the perineum (pouch-perineum distance) and by establishing the location of the fistula.…”

“…4 Prone cross-table radiography should be performed 20 to 24 hours after the initial examination to allow time for intraluminal pressure in the rectal pouch to increase. 4,7 Previous studies have shown that sonography is useful for classifying the imperforate anus type both by establishing the distance between the distal rectal pouch and the perineum (pouch-perineum distance) and by establishing the location of the fistula. [8][9][10][11][12][13][14][15] However, to the best of our knowledge, there have been no reports comparing the accuracy of diagnosing the imperforate anus type by using prone cross-table radiography versus sonography.…”

Anorectal Malformations in a Tertiary Pediatric Surgery Center from Romania: 20 Years of Experience

“…The diagnosis of ARMs in our series was mainly clinical, including routine imaging (thoracic, abdominal, pelvic and spinal X-rays) and invertography, abdominal ultrasound and contrast studies, along with endoscopic evaluation that aimed to evaluate the topography and extent of the lesion. The recent ARM-Net meeting brought minor changes to the preoperative management of ARMs regarding the 24 hours re-evaluation and cross-table lateral X-ray, compared to Levitt and Peña's flow chart [23,24]. It was suggested that in a newborn male with a perineal fistula, a cross-table lateral X-ray is unnecessary, this procedure being recommended only in cases of normal buttocks, normal spine, normal sacrum, and negative urinalysis on meconium; this protocol was extended to female neonates with visible fistula.…”