Complications After Surgery for Anorectal Malformations: An ARM-Net consortium Registry Study

Van Der Steeg, H.J.J.; Hageman, I.C.; Morandi, A.; Amerstorfer, E.E.; Sloots, C.E.J.; Jenetzky, E.; Stenström, P.; Samuk, I.; Fanjul, M.; Midrio, P.; Schmiedeke, E.; Iacobelli, B.D.; De Blaauw, I.; Van Rooij, I.A.L.M.; Aminoff, Dalia; Bagolan, Piero; Broens, Paul; Çavuşoğlu, YUSUF; Deluggi, Stefan; Divarci, Emre; Fascetti-Leon, Francesco; Vázquez, Araceli; Giné, Carlos; Giuliani, Stefano; Gorter, Ramon; Gosemann, Jan; Lacher, Martin; Grano, Caterina; Grasshoff-Derr, Sabine; Haanen, Michel; Holland-Cunz, Stefan; Krois, Wilfried; Leva, Ernesto; Lindert, Judith; Lisi, Gabriele; Ludwiczek, Johanna; Makedonsky, Igor; Marcelis, Carlo; Verhaak, Chris; Miserez, Marc; Mohideen, Mazeena; Prato, Alessio; Poš, Lucie; Škába, Richard; Reck-Burneo, Carlos; Reutter, Heiko; Rohleder, Stephan; Schukfeh, Nagoud; Schwarzer, Nicole; Till, Holger; Vilanova-Sánchez, Alejandra; Volk, Patrick; Witvliet, Marieke

doi:10.1016/j.jpedsurg.2025.162403

Complications After Surgery for Anorectal Malformations: An ARM-Net consortium Registry Study

Van Der Steeg H., Hageman I., Morandi A., Amerstorfer E., Sloots C., Jenetzky E., ...More

Journal of Pediatric Surgery, vol.60, no.9, 2025 (SCI-Expanded)

Publication Type: Article / Article
Volume: 60 Issue: 9
Publication Date: 2025
Doi Number: 10.1016/j.jpedsurg.2025.162403
Journal Name: Journal of Pediatric Surgery
Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CAB Abstracts, Veterinary Science Database
Keywords: ARM, ARM-Net registry, Multivariable analysis, Postoperative complications, Reconstructive, Risk factors
Gazi University Affiliated: Yes

Abstract

Objective: Establishing the incidence and types of complications following surgical intervention for ARM, primarily after reconstruction. Patient- and treatment-related risk factors were also determined. Background: Postoperative complications of ARM surgery vary widely, with data predominantly derived from single-center retrospective studies with limited number of patients. Whether factors such as ARM type, associated congenital anomalies, prior enterostomy, or type of reconstructive surgery affect complication incidence remains unclear. Methods: This multicenter cohort study was performed using the ARM-Net registry with prospectively collected data. Enterostomy-related and post-reconstructive complications in patients who underwent reconstructive surgery before the age of five years were recorded. Patients with more than 25 % missing data, unknown sex, ARM type, or reconstruction date, or without (information on) reconstruction or complications, were excluded. Multivariable analyses identified independent risk factors for the development of complications. Results: A total of 2,043 patients were eligible for analysis. Complications after enterostomy formation and closure occurred in 25 % and 12 % of patients, respectively. Post-reconstructive complications occurred in 25 % of patients, with wound complications comprising half of the complications. In a multivariable analysis, recto-bladder neck fistula, any associated anomaly, and the LAARP procedure were identified as independent risk factors for post-reconstructive complications. In contrast, anoplasty and mini-PSARP reduce the risk of complications. Conclusions: Post-reconstructive complications in ARM patients are common, and certain patient- and treatment-related characteristics affect postoperative outcomes. These results aid counselling and clinical decision-making, and may guide the operative planning of ARM types that are amenable to several different surgical approaches.