Accuracy of pre-operative fistula diagnostics in anorectal malformations
Tofft, Louise LU
; Salö, Martin
LU
; Arnbjörnsson, Einar
LU
and Stenström, Pernilla
LU
(2021)
In BMC Pediatrics
21(1).
- 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... (More)
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%.
(Less)
- author
- Tofft, Louise
LU
; Salö, Martin
LU
; Arnbjörnsson, Einar
LU
and Stenström, Pernilla
LU
- organization
- publishing date
- 2021-06-16
- type
- Contribution to journal
- publication status
- published
- subject
- in
- BMC Pediatrics
- volume
- 21
- issue
- 1
- article number
- 283
- publisher
- BioMed Central (BMC)
- external identifiers
-
- pmid:34134660
- scopus:85108120484
- ISSN
- 1471-2431
- DOI
- 10.1186/s12887-021-02761-6
- language
- English
- LU publication?
- yes
- id
- e09ab246-f824-4734-87fe-4ab51966edbe
- date added to LUP
- 2021-06-26 13:13:06
- date last changed
- 2024-04-20 08:02:09
@article{e09ab246-f824-4734-87fe-4ab51966edbe,
abstract = {{<p>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.</p><p>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.</p><p>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.</p><p>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%.</p>}},
author = {{Tofft, Louise and Salö, Martin and Arnbjörnsson, Einar and Stenström, Pernilla}},
issn = {{1471-2431}},
language = {{eng}},
month = {{06}},
number = {{1}},
publisher = {{BioMed Central (BMC)}},
series = {{BMC Pediatrics}},
title = {{Accuracy of pre-operative fistula diagnostics in anorectal malformations}},
url = {{http://dx.doi.org/10.1186/s12887-021-02761-6}},
doi = {{10.1186/s12887-021-02761-6}},
volume = {{21}},
year = {{2021}},
}