Can fecal continence be predicted in patients born with anorectal malformations?

Peter C. Minneci, Nationwide Children’s Hospital
Rashmi S. Kabre, Northwestern University Feinberg School of Medicine
Grace Z. Mak, The University of Chicago Medicine
Devin R. Halleran, Nationwide Children’s Hospital
Jennifer N. Cooper, Nationwide Children’s Hospital
Amin Afrazi, University of Wisconsin-Madison
Casey M. Calkins, Medical College of Wisconsin
Kristine Corkum, Northwestern University Feinberg School of Medicine
Cynthia D. Downard, University of Louisville
Peter Ehrlich, University of Michigan, Ann Arbor
Jason D. Fraser, Children's Mercy Hospitals and Clinics
Samir K. Gadepalli, University of Michigan, Ann Arbor
Michael A. Helmrath, Cincinnati Children's Hospital Medical Center
Jonathan E. Kohler, University of Wisconsin-Madison
Rachel Landisch, Medical College of Wisconsin
Matthew P. Landman, Indiana University School of Medicine
Constance Lee, Washington University School of Medicine in St. Louis
Charles M. Leys, University of Wisconsin-Madison
Daniel L. Lodwick, Nationwide Children’s Hospital
Jennifer McLeod, University of Michigan, Ann Arbor
Rodrigo Mon, University of Michigan, Ann Arbor
Beth McClure, University of Louisville
Beth Rymeski, Cincinnati Children's Hospital Medical Center
Jacqueline M. Saito, Washington University School of Medicine in St. Louis
Thomas T. Sato, Medical College of Wisconsin
Shawn D. St. Peter, Children's Mercy Hospitals and Clinics
Richard Wood, Nationwide Children’s Hospital
Marc A. Levitt, Nationwide Children’s Hospital
Katherine J. Deans, Nationwide Children’s Hospital

Document Type

Journal Article

Publication Date

6-1-2019

Journal

Journal of Pediatric Surgery

Volume

54

Issue

6

DOI

10.1016/j.jpedsurg.2019.02.035

Keywords

Anorectal malformation; Continence; Predictors; Sacral ratio; Spine

Abstract

© 2019 Elsevier Inc. Purpose: The purpose of this study was to identify factors associated with attaining fecal continence in children with anorectal malformations (ARM). Methods: We performed a multi-institutional cohort study of children born with ARM in 2007–2011 who had spinal and sacral imaging. Questions from the Baylor Social Continence Scale were used to assess fecal continence at the age of ≥ 4 years. Factors present at birth that predicted continence were identified using multivariable logistic regression. Results: Among 144 ARM patients with a median age of 7 years (IQR 6–8), 58 (40%)were continent. The rate of fecal continence varied by ARM subtype (p = 0.002)with the highest rate of continence in patients with perineal fistula (60%). Spinal anomalies and the lateral sacral ratio were not associated with continence. On multivariable analysis, patients with less severe ARM subtypes (perineal fistula, recto-bulbar fistula, recto-vestibular fistula, no fistula, rectal stenosis)were more likely to be continent (OR = 7.4, p = 0.001). Conclusion: Type of ARM was the only factor that predicted fecal continence in children with ARM. The high degree of incontinence, even in the least severe subtypes, highlights that predicting fecal continence is difficult at birth and supports the need for long-term follow-up and bowel management programs for children with ARM. Type of Study: Prospective Cohort Study. Level of Evidence: II.

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