title: Unexpected megarectum: A potential hidden source of complications in patients with anorectal malformation.
abstract: BACKGROUND
  Primary posterior sagittal anorectoplasty is recommended to repair anorectal malformations with rectoperineal or rectovestibular fistula. The aim of this study was to identify the impact of the presence of megarectum on the relative frequency of complications related to posterior sagittal anorectoplasty.
  
  
  METHODS
  We performed a cross-sectional retrospective study including patients with anorectal malformation, preoperative rectogram and surgically treated with primary or staged posterior sagittal anorectoplasty. Only complications related to anorectoplasty were analyzed and compared with the presence of megarectum.
  
  
  RESULTS
  Thirty patients aged 1 day to 7 years were included, 60% had megarectum. Sixteen patients had primary repair: 6 with megarectum and 10 without megarectum; complications occurred in four of the six with megarectum, 66.7%, and no complication were observed in the 10 patients without megarectum (F p=0.008). Fourteen patients had staged repair and no complications related to posterior sagittal anorectoplasty occurred in these patients.
  
  
  CONCLUSIONS
  Comprehensive preoperative evaluation in patients with anorectal malformation with rectoperineal or rectovestibular fistula could include a rectogram. Awareness of the presence of megarectum could be useful information in the decision to create a colostomy or perform a primary posterior sagittal anorectoplasty.
authors.affiliation: Centro Colorrectal para Niños de México, Hospital para el Niño Poblano, Boulevard del Niño Poblano 5307 Puebla, México 72190; Colorectal Center for Children of Children's Hospital Pittsburgh of UPMC, Children's Hospital of Pittsburgh of UPMC, One Children's Hospital Drive 4401 Penn Avenue, Pittsburgh, PA 15224, USA. Electronic address: luis.delatorre@chp.edu.
authors.forename: Luis
authors.initials: L
authors.lastname: De la Torre-Mondragón
authors.affiliation: Clínica de Cirugía Colorrectal, Instituto Nacional de Pediatría, Insurgentes Sur 3700-C, México DF, México 04530. Electronic address: claudiajbanuelosc@hotmail.com.
authors.forename: Claudia
authors.initials: C
authors.lastname: Bañuelos-Castañeda
authors.affiliation: Clínica de Cirugía Colorrectal, Instituto Nacional de Pediatría, Insurgentes Sur 3700-C, México DF, México 04530. Electronic address: santosjasso@hotmail.com.
authors.forename: Karla
authors.initials: K
authors.lastname: Santos-Jasso
authors.affiliation: Centro Colorrectal para Niños de México, Hospital para el Niño Poblano, Boulevard del Niño Poblano 5307 Puebla, México 72190. Electronic address: cirugiapediatrica@msn.com.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Ruiz-Montañez
mesh_terms: D001003:Anal Canal / Q000002:abnormalities* / Q000601:surgery; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000150:complications* / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D003125:Colostomy / Q000379:methods*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008531:Megacolon / Q000209:etiology* / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*; D012007:Rectum / Q000002:abnormalities* / Q000601:surgery; D012189:Retrospective Studies
keywords: Anorectal malformation; Imperforate anus; Megarectum; Rectogram; Rectoperineal fistula; Rectovestibular fistula