A standardized approach for the assessment and treatment of internationally adopted children with a previously repaired anorectal malformation (ARM)

• Published in: Journal of pediatric surgery 2016-11, Vol.51 (11), p.1864-1870
• Main Authors: Lane, Victoria A, Skerritt, Clare, Wood, Richard J, Reck, Carlos, Hewitt, Geri D, McCracken, Kate A, Jayanthi, Venkata R, DaJusta, Daniel, Ching, Christina, Deans, Katherine J, Minneci, Peter C, Levitt, Marc A
• Format: Article
• Language: English
• Subjects: Abnormalities, Multiple; Adopted; Adoption; Anal Canal - abnormalities; Anal Canal - surgery; Anorectal; Anorectal Malformations - diagnosis; Anorectal Malformations - surgery; Child; Child, Preschool; Diagnostic Imaging - methods; Digestive System Surgical Procedures - methods; Disease Management; Female; Humans; Infant; Male; Pediatrics; Rectum - abnormalities; Rectum - surgery; Redo; Reoperation - statistics & numerical data; Reoperative; Surgery
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2016.07.018

Abstract Introduction A significant number of internationally adopted children have congenital birth defects. As a specialist Center for colorectal diagnoses, we evaluate such children with an anorectal malformation (ARM) and have found that a significant number need a reoperation. Knowledge of the common complications following ARM surgery has led us to develop treatment algorithms for patients with unknown past medical and surgical history, a situation typically encountered in the adopted population. Methods The results of investigations, indications, and rate of reoperation were assessed for adopted children with an ARM evaluated between 2014 and 2016. Results 56 patients (28 males) were identified. 76.8% required re-operative surgery. Mislocation of the anus outside the sphincter complex was seen in 50% of males and 39.3% of females. Anal stricture, rectal prolapse, retained vaginal septum and a strictured vaginal introitus were also common. Conclusion The reoperative surgery rate in the internationally adopted child with an ARM is high. Complete, systematic evaluation of these children is required to identify complications following initial repair. Development of mechanisms to improve the primary surgical care these children receive is needed.