WOFAPS 2025 8th World Congress of Pediatric Surgery

Francesca Galbiati ¹, Anna Morandi ¹, Francesca Maestri ¹, Louise Tofft ², Christina Graneli ², Pernilla Stenstrom ², Ernesto Leva ¹

¹ Department of pediatric surgery, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
² Department of Pediatric surgery, Skane University Hospital, Lund University, Lund, Sweden

Purpose: post-operative anal dilations after anorectoplasty for anorectal malformations (ARM) have long been considered fundamental. However, there is no consensus on their efficacy. We therefore aimed to evaluate the outcomes of routine dilations compared to calibrations at scheduled appointments in terms of anal diameter (AD), incidence of stenosis and prolapse.

Methods: a retrospective comparative study was conducted between two centers: one with a routine dilations protocol, one without. Patients who completed surgical correction, operated between 2015 and 2023, on active follow-up, were included. AD (Hegar size) was measured at the end of dilations protocol in the first center and at calibration at scheduled appointments in the second. The ratio between patient’s AD and the expected diameter for age (according to Peña) was calculated.

Results: overall, 194 patients were included (Group-1: routine dilations, n=113; Group-2: no dilations, n=81). The AD assessment was performed at a median time of 2 months postoperatively for both groups, with the patients having a median age of 6 months (IQR 5-9) vs 5 months (IQR 2-7). The mean AD was significantly larger in group-1 than in group-2 (12±0.75 vs 8.5±2.39, p<0.001) as well as the ratio (0.92±0.06 vs 0.69±0.13, p<0.001). This difference remained across most ARM-subtypes.There was no difference in incidence of stenosis (4.4% vs 4.9%, p=1) and prolapse (15% vs 19.7%, p=0.44).

Conclusion: patients who underwent routine anal dilations after anorectoplasty have a higher AD. However, the rates of stenosis and prolapse do not differ.