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

van der Steeg HJ, Hageman IC, Morandi A, Amerstorfer EE, Sloots CE, Jenetzky E, Stenström P, Samuk I, Fanjul M, Midrio P, Schmiedeke E, Iacobelli BD, de Blaauw I, van Rooij IA, Aminoff D, Bagolan P, Broens P, Çavuşoğlu Y, Deluggi S, Divarci E, Fascetti-Leon F, Vázquez AG, Giné C, Giuliani S, Gorter RR, Gosemann J, Lacher M, Grano C, Grasshoff-Derr S, Haanen M, Holland-Cunz S, Krois W, Leva E, Lindert J, Lisi G, Ludwiczek J, Makedonsky I, Marcelis C, Verhaak C, Miserez M, Mohideen M, Prato AP, Poš L, Škába R, Reck-Burneo C, Reutter HM, Rohleder S, Schukfeh N, Schwarzer N, Till H, Vilanova-Sánchez A, Volk P, Witvliet M (2025)

Publication Type: Journal article

Publication year: 2025

Journal

Book Volume: 60

Article Number: 162403

Journal Issue: 9

DOI: 10.1016/j.jpedsurg.2025.162403

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.

Authors with CRIS profile

Involved external institutions

Wilhelmina Kinderziekenhuis Netherlands (NL) Fondazione IRCCS Ca' Granda - Ospedale Maggiore Policlinico Italy (IT) Medizinische Universität Graz Austria (AT) Erasmus MC - Sophia Children’s Hospital Netherlands (NL) Universitätsmedizin der Johannes Gutenberg-Universität Mainz Germany (DE) Lund University / Lunds universitet Sweden (SE) Tel Aviv University Israel (IL) Hospital General Universitario Gregorio Marañón Spain (ES) Radboud University Nijmegen Medical Centre / Radboudumc of voluit Radboud Universitair Medisch Centrum (UMC) Netherlands (NL) Ospedale Ca' Foncello Italy (IT) Klinikverbund Bremen (Gesundheit Nord) Germany (DE) Ospedale Pediatrico Bambino Gesu Italy (IT) AIMAR OdV – Italian Association of Anorectal Malformations Italy (IT) University Medical Center Groningen (UMCG) / Universitair Medisch Centrum Groningen Netherlands (NL) Gazi University Turkey (TR) Kepler Universitätsklinikum (KUK) Austria (AT) Ege University / Ege Üniversitesi Turkey (TR) University of Padua / Universita degli Studi di Padova Italy (IT) Hospital Universitario 12 de Octubre Spain (ES) Vall d'Hebron University Hospital / Hospital Universitari Vall d'Hebron Spain (ES) Great Ormond Street Hospital (GOSH) United Kingdom (GB) Academic Medical Centre / Academisch Medisch Centrum (AMC) Netherlands (NL) Universitätsklinikum Leipzig Germany (DE) Università degli studi "La Sapienza" Italy (IT) Bürger­hospital Frankfurt Germany (DE) Universitäts-Kinderspital beider Basel (UKBB) Switzerland (CH) Medizinische Universität Wien Austria (AT) Universitätsmedizin Rostock Germany (DE) Ospedale Civile Santo Spirito Italy (IT) Johannes Kepler Universität (JKU) Linz Austria (AT) Dnipropetrovsk Regional Clinical Hospital named after I.I. Mechnykov / Dnepropetrovsk Children's Municipal Clinical Hospital #5 Ukraine (UA) University Hospital Leuven (UZ) / Universitaire ziekenhuizen Leuven Belgium (BE) SoMA Austria Austria (AT) Azienda Ospedaliera Nazionale SS.Antonio e Biagio e C.Arrigo Italy (IT) Motol University Hospital / Fakultní nemocnice v Motole Czech Republic (CZ) Landesklinikum Baden-Mödling Austria (AT) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE) SoMA e.V. Germany (DE) Hospital Universitario La Paz Spain (ES) Universitätsklinikum Heidelberg Germany (DE)

How to cite

APA:

van der Steeg, H.J., Hageman, I.C., Morandi, A., Amerstorfer, E.E., Sloots, C.E., Jenetzky, E.,... Witvliet, M. (2025). Complications After Surgery for Anorectal Malformations: An ARM-Net consortium Registry Study. Journal of Pediatric Surgery, 60(9). https://doi.org/10.1016/j.jpedsurg.2025.162403

MLA:

van der Steeg, H. J.J., et al. "Complications After Surgery for Anorectal Malformations: An ARM-Net consortium Registry Study." Journal of Pediatric Surgery 60.9 (2025).

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