Current practice regarding the diagnosis and treatment of anorectal malformations in female patients: a multicenter questionnaire survey in Japan.

PURPOSE: This study aimed to investigate the current practices in the diagnosis and surgical management of anorectal malformations (ARMs) in female patients in Japan, specifically focusing on anovestibular fistula (AVF), rectovaginal fistula (RVF), and persistent cloaca (PC).

METHODS

An anonymous online survey was conducted with 61 institutional members of the Japanese Study Group for Anorectal Anomalies.

RESULTS

Sixty-one institutions (100%) completed the survey. For AVF, fistulography/vaginography was the most common diagnostic method (98.4%), and anorectoplasty was usually performed at 3-6 months of age (86.9%) using anterior sagittal anorectoplasty (62.3%) or anal transposition (39.3%). Distal colostography (100%), MRI (71.7%), and cystscopy/urethroscopy/vaginoscopy (83.3%) were commonly used for PC. Patients with PC underwent anorectoplasty at 7-24 months (93.3%), predominantly posterior sagittal anorecto-urethro-vaginoplasty (PSARUVP) (41.7%), or laparoscopy-assisted anorectoplasty (LAARP) (43.3%). A subgroup analysis revealed that PSARUVP used blunt dissection (70.0% vs. 28.6%, p < 0.05) and visual confirmation by opening the rectum (80.0% vs. 4.8%, p < 0.001) significantly more often than LAARP for PC.

CONCLUSION

This nationwide survey revealed distinct patterns in the diagnostic timing and surgical approaches for female ARMs in Japan, highlighting the varying preferences in fistula management techniques across different types of malformations.