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

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

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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