Patient-reported outcomes of Children with an Anorectal Malformation
A 2024 survey by Witt et al. at Nationwide Children's was published in the Annals of Surgery examining patients with anorectal malformation
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:10 ↗
The survey looked at over 900 patients with anorectal malformation
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:11 ↗
There was no difference in continence for patients based on sacral ratio alone in regards to quality of life
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:21 ↗
Patients who are incontinent had a 20-point lower quality of life compared to patients who were continent or clean on enemas
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:29 ↗
The sacral ratio may not be as strong a predictor of continence as patients age
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:38 ↗
Bowel management may actually matter more than sacral ratio in predicting continence outcomes
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:38 ↗
Quality of life is significantly lower for patients with incontinence compared to those clean on enemas
Host summaryJill Knepprath summarizing a resource — not the host's own clinical position0:51 ↗
Complications of Anorectal Malformations with Dr. Marc Levitt
Anorectal malformations are commonly not properly diagnosed or completely missed in the newborn period.
clinicalMarc Levitt2:57 ↗
Male babies with perineal fistula may pass meconium and no one notices anything wrong with their anorectal anatomy, typically presenting in the first year of life with severe constipation.
clinicalMarc Levitt3:06 ↗
A newborn anus should accept a size 12 Hagar dilator and a 1-year-old should accept a size 15.
clinicalMarc Levitt6:13 ↗
Relocating a perineal fistula into the sphincters improves anatomy but does not completely fix constipation; patients will inherently have some constipation requiring aggressive treatment.
clinicalMarc Levitt4:54 ↗
If a perineal fistula is not centered in the sphincter, patients with loose stool will soil, and athletic activity will cause soiling because sphincter squeeze cannot completely close the hole.
clinicalMarc Levitt5:38 ↗
In females, diagnostic criteria for perineal fistula are: hole too close to vagina (inadequate perineal body), inadequate hole size by Hagar dilators, and hole not centered in sphincter.
clinicalMarc Levitt8:02 ↗
If a female's anal opening is adequate size and centered in the sphincter, even if appearing slightly anterior with short perineal body, no surgery is needed; the perineal body will lengthen with growth.
clinicalMarc Levitt8:47 ↗
The standard practice of checking temperature on forehead or ear rather than rectally makes it easier to miss anorectal malformations in newborns.
opinionMarc Levitt4:25 ↗
An anesthesia nerve stimulator costing $150 with appropriate needle probes works as well as commercial $15,000 stimulators for identifying sphincter muscles.
clinicalMarc Levitt11:06 ↗
The most common colostomy error is opening too distal in the sigmoid, restricting the ultimate pull-through by the location of the colostomy or mucous fistula.
clinicalMarc Levitt17:18 ↗
Incompletely diverting loop colostomies allow stool to spill across and contaminate the distal segment, leading to urinary tract infections.
clinicalMarc Levitt17:45 ↗
With transverse colostomy and large rectourethral fistula, the left colon absorbs urine which doesn't exit the mucous fistula, potentially causing acidosis from urine absorption.
clinicalMarc Levitt18:38 ↗
Prolapse risk depends on colostomy location: mid-transverse allows bilateral prolapse, hepatic flexure allows only distal prolapse, proximal sigmoid allows only distal prolapse because left colon is fixed to retroperitoneum.
clinicalMarc Levitt19:58 ↗
Marking the sphincter ellipse on skin surface before making any incision prevents confusion from muscle stimulation after dissection is open, avoiding misplaced anoplasty.
clinicalMarc Levitt21:30 ↗
A distal colostogram showing flattening of the rectum corresponding to the pubococcygeal line indicates insufficient contrast or pressure; more pressure is needed to overcome the sphincters and reveal the true rectal position and fistula.
clinicalMarc Levitt24:26 ↗
Fistula level is determined by viewing the urethra as a reverse C or elbow: fistula at or below the elbow is bulbar, above the elbow is prostatic, at bladder neck is bladder neck fistula.
clinicalMarc Levitt25:23 ↗
Bulbous rectum on colostogram may be reachable posterior sagittally and difficult laparoscopically; tapered rectum is better approached laparoscopically.
clinicalMarc Levitt25:55 ↗
Opening posterior sagittally without knowing exact rectal location risks finding and potentially mobilizing bladder neck instead of rectum.
clinicalMarc Levitt27:00 ↗
Bulbar and low prostatic fistulas with bulbous rectum are best approached posterior sagittally; high prostatic with tapered rectum and bladder neck fistulas are best approached laparoscopically.
clinicalMarc Levitt30:09 ↗
Attempting laparoscopy for bulging rectum below peritoneal reflection at low prostatic or bulbar level risks leaving behind a remnant of the original fistula (roof) if the surgeon is timid.
clinicalMarc Levitt30:43 ↗
Laparoscopy replaces laparotomy, not PSARP; a mini-PSARP during laparoscopy allows safe entry through peritoneal reflection and tacking rectum to posterior muscle complex to prevent prolapse.
opinionMarc Levitt31:48 ↗
Rectal prolapse occurs in about 3% of cases, particularly in patients without great muscles.
epidemiologicalMarc Levitt33:35 ↗
Rectal prolapse more than 3 millimeters should be treated because it causes bleeding, mucus, and can inhibit bowel control in patients with good muscle potential.
clinicalMarc Levitt34:14 ↗