title: Perioperative Nutritional Management in Congenital Perineal and Vestibular Fistulas: A Systematic Review.
abstract: BACKGROUND
  Surgical advancements have led to improved outcomes for children with congenital anorectal malformations with vestibular and perineal fistulas. However, the effect of perioperative nutritional management is debated and guidelines have not yet been established.
  
  
  OBJECTIVE
  The study aims to give an overview of available published evidence, regarding the impact of different perioperative nutritional management protocols on surgical outcome.
  
  
  METHODS
  A systematic literature review was conducted using PubMed, Embase, Cochrane Library, and CINAHL databases. All original articles concerning perioperative nutrition in children with vestibular and perineal fistulas were included. Methodological quality was assessed with the Rangel score. Included studies were subdivided into two groups: early enteral nutrition and prolonged fasting with or without parenteral nutrition.
  
  
  RESULTS
  The database search resulted in 768 publications. Nine studies were eligible for inclusion. Wound complications were present in 56 of the 1,557 patients (4%) in whom this was assessed, and were more frequently seen in the prolonged fasting group (2 vs. 10%, p < 0.0001). Regarding the long-term outcome, constipation (grade II-III) was seen in 4% of the early feeding group, compared with 13% in the prolonged fasting group (p < 0.0001).
  
  
  CONCLUSIONS
  This systematic review presents an overview of studies reporting on perioperative nutritional management in children with perineal and vestibular fistulas. Although study quality is low and study heterogeneity may also influence our results, early enteral feeding seems to be the preferable postoperative feeding strategy. Both early wound complications as well as long-term complications, in terms of clinically relevant constipation, seem to be lower in the early enteral feeding group. However, a prospective randomized, multicentered trial should be initiated to draw definitive conclusions regarding this matter.
authors: Department of Surgery-Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Amalia Children's Hospital, Nijmegen, The Netherlands.
authors: Marrigje Josien
authors: MJ
authors: Hofmeester
authors: Department of Surgery-Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Amalia Children's Hospital, Nijmegen, The Netherlands.
authors: Jos M T H
authors: JM
authors: Draaisma
authors: Department of Surgery-Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
authors: Hendt P
authors: HP
authors: Versteegh
authors: Department of Surgery-Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Amalia Children's Hospital, Nijmegen, The Netherlands.
authors: Elizabeth C P
authors: EC
authors: Huibregtse
authors: Department of Surgery-Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Amalia Children's Hospital, Nijmegen, The Netherlands.
authors: Iris A L M
authors: IA
authors: van Rooij
authors: Department of Surgery-Pediatric Surgery, Radboudumc-Amalia Children's Hospital, Amalia Children's Hospital, Nijmegen, The Netherlands.
authors: Ivo
authors: I
authors: de Blaauw
mesh_terms: D001003:Anal Canal / Q000002:abnormalities*; D005260:Female; D005402:Fistula / Q000151:congenital* / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D018529:Nutritional Support; D010502:Perineum / Q000002:abnormalities*; D011182:Postoperative Care / Q000379:methods*; D012007:Rectum / Q000002:abnormalities*; D014621:Vagina / Q000002:abnormalities*