Survey on the management of anorectal malformations (ARM) in European pediatric surgical centers of excellence

Purpose: Various management strategies for anorectal malformations (ARM) have been proposed. The aim of this study was to assess the current management in centers of excellence in Europe. Methods: An online survey on the pre- and post-operative concepts, surgical techniques, and the management of complications was sent to the representative experts of 28 selected European centers of pediatric surgery with special expertise in the treatment of ARM. Results: The survey was completed by 25 experts from 14 countries. To assess the level of the rectal pouch in newborns 60 % of participants perform a prone cross-table X-ray and 52 % ultrasound. If an ostomy is required, 84 % create divided Peña stomas. Primary repair in the newborn period is performed in females with rectoperineal (92 %), rectovestibular (60 %), and no fistula (32 %), and in males with rectoperineal (92 %), rectourinary (17 %) and no fistula (38 %). For 68 % of surgeons, the PSARP is the preferred surgical approach for “low” malformations. Laparoscopically assisted pull-throughs are routinely performed by 48 % of experts for ARM with bladderneck and 28 % for rectoprostatic fistula. 88 % perform postoperative dilations. Conclusions: The management of ARM in Europe is very heterogeneous. High-quality clinical studies are needed to provide scientific evidence for the optimal treatment strategies.