Annual Renal Surveillance With Ultrasound in All Anorectal Malformations May Not Be Necessary.

BACKGROUND

Children with anorectal malformations (ARMs) are at risk of renal anomalies. Therefore, we obtain annual renal ultrasounds (RUS) regardless of symptoms or complexity. The utility of aggressive screening in all ARM is unknown. Thus, we aimed to determine outcomes in children with all ARM managed on this protocol.

METHODS

We performed a single-institution review of children managed at a large pediatric colorectal center from 2014 to 2023 with less severe ARM (rectoperineal fistula, rectovaginal fistula, rectovestibular fistula, rectal/anal stenosis, and rectal atresia) with RUS obtained within 2 years of primary repair. We evaluated all RUS before and after repair. Demographics and clinical variables were collected, and descriptive statistics were computed.

RESULTS

There were 333 children meeting inclusion criteria; 197 had a postoperative RUS within two years of repair. Most (70.1 %) had a normal first postoperative RUS, and only four (2.0 %) progressed to become abnormal on subsequent studies. Only one of these patients (0.5 %) was asymptomatic at the time of RUS and had a finding necessitating further intervention. Children with an initially normal RUS underwent a median of 3 further RUS [IQR: 2-4], with 33 children (24.6 %) undergoing five or more normal RUS. Overall, 197 children with a normal postoperative RUS needed to be screened yearly to find one asymptomatic renal anomaly.

CONCLUSION

In a large cohort of children with mild ARM, only one child (0.5 %) benefited from screening RUS with an asymptomatic renal anomaly requiring intervention, suggesting that if RUS after primary repair of a mild ARM is normal, additional screening of the asymptomatic patient is not necessary.

LEVEL OF EVIDENCE: III = Retrospective Comparative Study.