title: A standardized approach for the assessment and treatment of internationally adopted children with a previously repaired anorectal malformation (ARM).
abstract: BACKGROUND
  A significant number of internationally adopted children have congenital birth defects. As a specialist center for colorectal diagnoses, we evaluate such children with an anorectal malformation (ARM) and have found that a significant number need a reoperation. Knowledge of the common complications following ARM surgery has led us to develop treatment algorithms for patients with unknown past medical and surgical history, a situation typically encountered in the adopted population.
  
  
  METHODS
  The results of investigations, indications, and rate of reoperation were assessed for adopted children with an ARM evaluated between 2014 and 2016.
  
  
  RESULTS
  56 patients (28 males) were identified. 76.8% required reoperative surgery. Mislocation of the anus outside the sphincter complex was seen in 50% of males and 39.3% of females. Anal stricture, rectal prolapse, retained vaginal septum, and a strictured vaginal introitus were also common.
  
  
  CONCLUSIONS
  The reoperative surgery rate in the internationally adopted child with an ARM is high. Complete, systematic evaluation of these children is required to identify complications following initial repair. Development of mechanisms to improve the primary surgical care these children receive is needed.
authors.affiliation: Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH, USA. Electronic address: Vic5lane@gmail.com.
authors.forename: Victoria A
authors.initials: VA
authors.lastname: Lane
authors.affiliation: Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH, USA. Electronic address: clareskerritt@nhs.net.
authors.forename: Clare
authors.initials: C
authors.lastname: Skerritt
authors.affiliation: Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH, USA. Electronic address: richard.wood@nationwidechildrens.org.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Wood
authors.affiliation: Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH, USA. Electronic address: carlos.reck@nationwidechildrens.org.
authors.forename: Carlos
authors.initials: C
authors.lastname: Reck
authors.affiliation: Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH, USA; Section of Gynecology, Nationwide Children's Hospital, Columbus, OH, USA. Electronic address: geri.hewitt@nationwidechildrens.org.
authors.forename: Geri D
authors.initials: GD
authors.lastname: Hewitt
authors.affiliation: Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH, USA; Section of Gynecology, Nationwide Children's Hospital, Columbus, OH, USA. Electronic address: kate.mcccracken@nationwidechildrens.org.
authors.forename: Kate A
authors.initials: KA
authors.lastname: McCracken
authors.affiliation: Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH, USA; Section of Urology, Nationwide Children's Hospital, Columbus, OH, USA. Electronic address: Rama.jayanthi@nationwdiechildrens.org.
authors.forename: Venkata R
authors.initials: VR
authors.lastname: Jayanthi
authors.affiliation: Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH, USA; Section of Urology, Nationwide Children's Hospital, Columbus, OH, USA. Electronic address: Daniel.dajusta@nationwidechildrens.org.
authors.forename: Daniel
authors.initials: D
authors.lastname: DaJusta
authors.affiliation: Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH, USA; Section of Urology, Nationwide Children's Hospital, Columbus, OH, USA. Electronic address: Christina.ching@nationwidechildrens.org.
authors.forename: Christina
authors.initials: C
authors.lastname: Ching
authors.affiliation: Center for Outcomes Research (CSOR), Nationwide Children's Hospital, Columbus, OH, USA. Electronic address: Katherine.deans@nationwdiechildrens.org.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Deans
authors.affiliation: Center for Outcomes Research (CSOR), Nationwide Children's Hospital, Columbus, OH, USA. Electronic address: peter.minneci@nationwidechildrens.org.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Minneci
authors.affiliation: Center for Colorectal and Pelvic Reconstruction (CCPR), Nationwide Children's Hospital, Columbus, OH, USA. Electronic address: marc.levitt@nationwidechildrens.org.
authors.forename: Marc A
authors.initials: MA
authors.lastname: Levitt
mesh_terms: D000015:Abnormalities, Multiple; D000300:Adoption; D001003:Anal Canal / Q000002:abnormalities / Q000601:surgery*; D000071056:Anorectal Malformations / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003952:Diagnostic Imaging / Q000379:methods*; D013505:Digestive System Surgical Procedures / Q000379:methods*; D019468:Disease Management; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012007:Rectum / Q000002:abnormalities / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data
keywords: Adopted; Anorectal; Redo; Reoperative; Surgery