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Anorectal prolapse after anorectal reconstruction : Incidence and risk factors according to the ARM-Net Consortium

Stenström, Pernilla LU orcid ; Maestri, Francesca ; Aminoff, Dalia ; de Blaauw, Ivo ; Ludwiczek, Johanna ; Midrio, Paola ; Prato, Alessio Pini ; Vilanova-Sanchez, Alejandra ; Morandi, Anna and van Rooij, Iris (2025) In Colorectal Disease 27(2).
Abstract

Aim: There is a knowledge gap regarding which patients with anorectal malformations (ARMs) are at highest risk of anorectal prolapse (AP), and which risk factors predispose to AP in ARM. The aims of the study were to define the frequency of AP after ARM reconstruction, and explore risk factors. Method: Data from the ARM-Net registry inserted between 2007 and 2023 were used. Inclusion criteria were the reconstruction performed, no stoma at 1-year follow-up and all data available at 1-year follow-up. The statistics used were univariable and multivariable logistic regression models. Results: After exclusions the incidence of AP was 163 in 1117 patients (14.6%) in data inserted by 31 centres from 12 countries. The AP incidence was unevenly... (More)

Aim: There is a knowledge gap regarding which patients with anorectal malformations (ARMs) are at highest risk of anorectal prolapse (AP), and which risk factors predispose to AP in ARM. The aims of the study were to define the frequency of AP after ARM reconstruction, and explore risk factors. Method: Data from the ARM-Net registry inserted between 2007 and 2023 were used. Inclusion criteria were the reconstruction performed, no stoma at 1-year follow-up and all data available at 1-year follow-up. The statistics used were univariable and multivariable logistic regression models. Results: After exclusions the incidence of AP was 163 in 1117 patients (14.6%) in data inserted by 31 centres from 12 countries. The AP incidence was unevenly distributed between the centres (interquartile range 6.3%–21.7%). AP was more frequent in boys than girls (20.9% vs. 8.1%; P < 0.001). In both sexes the incidence of AP was higher in complex ARM subtypes (P < 0.001). AP was most frequent after laparotomy- and laparoscopic-assisted reconstructions (50.0% and 37.5%, respectively). Spinal and sacral anomalies constituted risk factors for AP in univariable analyses, while tethered cord did not. Adjusted risk factors for AP were severity of ARM subtype (40% in long-channel cloaca and bladder neck fistula, OR 3.1, 95% CI 1.0–10.2), laparotomy-assisted posterior sagittal anorectoplasty (50%, OR 3.7, 95% CI 1.6–8.4) and larger neo-anus at 1-year follow-up (Hegar 13.6 vs. 13.1; OR 1.2, 95% CI 1.1–1.4). Constipation was not a risk factor for AP. Conclusion: Anorectal prolapse is a frequent postoperative sequela. Adjusted analyses indicate that severity of ARM, abdominal open access during reconstruction and larger size of anus are risk factors.

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author
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author collaboration
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
anal size, anorectal malformations, anorectal prolapse
in
Colorectal Disease
volume
27
issue
2
article number
e70010
publisher
John Wiley & Sons Inc.
external identifiers
  • scopus:85216884148
  • pmid:39894996
ISSN
1462-8910
DOI
10.1111/codi.70010
language
English
LU publication?
yes
id
cdd22850-dd25-42e7-bb94-6baf14289092
date added to LUP
2025-04-07 12:25:19
date last changed
2025-07-15 04:41:17
@article{cdd22850-dd25-42e7-bb94-6baf14289092,
  abstract     = {{<p>Aim: There is a knowledge gap regarding which patients with anorectal malformations (ARMs) are at highest risk of anorectal prolapse (AP), and which risk factors predispose to AP in ARM. The aims of the study were to define the frequency of AP after ARM reconstruction, and explore risk factors. Method: Data from the ARM-Net registry inserted between 2007 and 2023 were used. Inclusion criteria were the reconstruction performed, no stoma at 1-year follow-up and all data available at 1-year follow-up. The statistics used were univariable and multivariable logistic regression models. Results: After exclusions the incidence of AP was 163 in 1117 patients (14.6%) in data inserted by 31 centres from 12 countries. The AP incidence was unevenly distributed between the centres (interquartile range 6.3%–21.7%). AP was more frequent in boys than girls (20.9% vs. 8.1%; P &lt; 0.001). In both sexes the incidence of AP was higher in complex ARM subtypes (P &lt; 0.001). AP was most frequent after laparotomy- and laparoscopic-assisted reconstructions (50.0% and 37.5%, respectively). Spinal and sacral anomalies constituted risk factors for AP in univariable analyses, while tethered cord did not. Adjusted risk factors for AP were severity of ARM subtype (40% in long-channel cloaca and bladder neck fistula, OR 3.1, 95% CI 1.0–10.2), laparotomy-assisted posterior sagittal anorectoplasty (50%, OR 3.7, 95% CI 1.6–8.4) and larger neo-anus at 1-year follow-up (Hegar 13.6 vs. 13.1; OR 1.2, 95% CI 1.1–1.4). Constipation was not a risk factor for AP. Conclusion: Anorectal prolapse is a frequent postoperative sequela. Adjusted analyses indicate that severity of ARM, abdominal open access during reconstruction and larger size of anus are risk factors.</p>}},
  author       = {{Stenström, Pernilla and Maestri, Francesca and Aminoff, Dalia and de Blaauw, Ivo and Ludwiczek, Johanna and Midrio, Paola and Prato, Alessio Pini and Vilanova-Sanchez, Alejandra and Morandi, Anna and van Rooij, Iris}},
  issn         = {{1462-8910}},
  keywords     = {{anal size; anorectal malformations; anorectal prolapse}},
  language     = {{eng}},
  number       = {{2}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{Colorectal Disease}},
  title        = {{Anorectal prolapse after anorectal reconstruction : Incidence and risk factors according to the ARM-Net Consortium}},
  url          = {{http://dx.doi.org/10.1111/codi.70010}},
  doi          = {{10.1111/codi.70010}},
  volume       = {{27}},
  year         = {{2025}},
}