title: Survey on the management of anorectal malformations (ARM) in European pediatric surgical centers of excellence.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Pediatric Surgery, Fondazione IRCCS Ca´Granda, Ospedale Maggiore Policlinico, Via Commenda 10, 20122, Milan, Italy, anna_morandi@hotmail.it.
authors.forename: Anna
authors.initials: A
authors.lastname: Morandi
authors.forename: Benno
authors.initials: B
authors.lastname: Ure
authors.forename: Ernesto
authors.initials: E
authors.lastname: Leva
authors.forename: Martin
authors.initials: M
authors.lastname: Lacher
mesh_terms: D001003:Anal Canal / Q000002:abnormalities* / Q000601:surgery; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000601:surgery*; D005060:Europe; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D012007:Rectum / Q000002:abnormalities* / Q000601:surgery
references.citation: J Pediatr Surg. 2011 Aug;46(8):1609-17
references.pmid: 21843731
references.citation: J Ultrasound Med. 2000 Mar;19(3):211-6
references.pmid: 10709838
references.citation: J Pediatr Surg. 2012 Jan;47(1):209-12
references.pmid: 22244419
references.citation: J Pediatr Surg. 2000 Jun;35(6):927-30; discussion 930-1
references.pmid: 10873037
references.citation: J Pediatr Surg. 1999 Sep;34(9):1315-9
references.pmid: 10507419
references.citation: Scand J Gastroenterol. 2012 Jan;47(1):99-107
references.pmid: 22171974
references.citation: S Afr J Surg. 2011 Mar 14;49(1):39-43
references.pmid: 21933483
references.citation: AJR Am J Roentgenol. 1983 Feb;140(2):227-9
references.pmid: 6600334
references.citation: J Pediatr Surg. 1992 Jan;27(1):85-8
references.pmid: 1552453
references.citation: Cleft Palate Craniofac J. 2014 Sep;51(5):e102-9
references.pmid: 24506345
references.citation: J Pediatr Surg. 1982 Dec;17(6):796-811
references.pmid: 6761417
references.citation: Pediatr Cardiol. 2000 Jul-Aug;21(4):353-7
references.pmid: 10865012
references.citation: Radiology. 2003 Jul;228(1):226-9
references.pmid: 12738873
references.citation: J Pediatr Surg. 2011 Sep;46(9):1689-94
references.pmid: 21929975
references.citation: J Pediatr Surg. 1982 Oct;17(5):638-43
references.pmid: 7175658
references.citation: Eur J Pediatr Surg. 2011 Mar;21(2):82-7
references.pmid: 21157692
references.citation: Pediatr Radiol. 2001 Dec;31(12 ):858-62
references.pmid: 11727021
references.citation: Ann Surg. 1930 Jul;92(1):77-81
references.pmid: 17866345
references.citation: J Pediatr Surg. 2012 Mar;47(3):565-70
references.pmid: 22424354
references.citation: Neurosurgery. 2004 Mar;54(3):553-63; discussion 563-5
references.pmid: 15028128
references.citation: J Pediatr Surg. 1978 Oct;13(6):497-8
references.pmid: 712524
references.citation: J Pediatr Surg. 2014 Jan;49(1):87-90; discussion 90
references.pmid: 24439587
references.citation: Semin Pediatr Surg. 1995 Feb;4(1):35-47
references.pmid: 7728507
references.citation: J Pediatr Surg. 2006 Apr;41(4):748-56; discussion 748-56
references.pmid: 16567188
references.citation: J Laparoendosc Adv Surg Tech A. 2009 Apr;19 Suppl 1:S233-5
references.pmid: 18973467
references.citation: J Pediatr Surg. 2009 Jun;44(6):1257-60; discussion 1260
references.pmid: 19524750
references.citation: Dev Psychopathol. 2006 Winter;18(1):233-51
references.pmid: 16478561
references.citation: J Pediatr Surg. 1978 Oct;13(6):499-504
references.pmid: 712525
references.citation: J Pediatr Surg. 1998 Mar;33(3):468-75
references.pmid: 9537559
references.citation: J Pediatr Surg. 2010 Dec;45(12):2390-3
references.pmid: 21129552
references.citation: BJU Int. 2004 Oct;94(6):893-4
references.pmid: 15476529
references.citation: BJU Int. 2003 Apr;91(6):540-4
references.pmid: 12656912
references.citation: J Pediatr Surg. 1998 Apr;33(4):670-1
references.pmid: 9574780
references.citation: J Pediatr Surg. 2013 Feb;48(2):367-71
references.pmid: 23414867
references.citation: Ann R Coll Surg Engl. 2011 Jan;93(1):34-8
references.pmid: 20738896