Preliminary report on the International Conference for the Development of Standards for the Treatment of Anorectal Malformations.
BACKGROUND
Anorectal malformations (ARM) are common congenital anomalies seen throughout the world. Comparison of outcome data has been hindered because of confusion related to classification and assessment systems.


METHODS
The goals of the Krinkenbeck Conference on ARM was to develop standards for an International Classification of ARM based on a modification of fistula type and adding rare and regional variants, and design a system for comparable follow up studies.


RESULTS
Lesions were classified into major clinical groups based on the fistula location (perineal, recto-urethral, recto-vesical, vestibular), cloacal lesions, those with no fistula and anal stenosis. Rare and regional variants included pouch colon, rectal atresia or stenosis, rectovaginal fistula, H-fistula and others. Groups would be analyzed according to the type of procedure performed stratified for confounding associated conditions such as sacral anomalies and tethered cord. A standard method for postoperative assessment of continence was determined.


CONCLUSIONS
A new International diagnostic classification system, operative groupings and a method of postoperative assessment of continence was developed by consensus of a large contingent of participants experienced in the management of patients with ARM. These methods should allow for a common standardization of diagnosis and comparing postoperative results.
Holschneider
Alexander
A
Department of Surgery, Kinderkrankenhaus of the City of Cologne, Amsterdamerstr. 59, 50735 Cologne, Germany. holschneidera@kliniken-koeln.de
Hutson
John
J
Peña
Albert
A
Beket
Elhamy
E
Chatterjee
Subir
S
Coran
Arnold
A
Davies
Michael
M
Georgeson
Keith
K
Grosfeld
Jay
J
Gupta
Devendra
D
Iwai
Naomi
N
Kluth
Dieter
D
Martucciello
Giuseppe
G
Moore
Samuel
S
Rintala
Risto
R
Smith
E Durham
ED
Sripathi
D V
DV
Stephens
Douglas
D
Sen
Sudipta
S
Ure
Benno
B
Grasshoff
Sabine
S
Boemers
Thomas
T
Murphy
Feilin
F
Söylet
Yunus
Y
Dübbers
Martin
M
Kunst
Marc
M
D001003:Anal Canal / Q000002:abnormalities* / Q000601:surgery*; D002648:Child; D013505:Digestive System Surgical Procedures / Q000592:standards; D006801:Humans; D012007:Rectum / Q000002:abnormalities* / Q000601:surgery*