Tag Archive for: continence

Rectoperineal fistula in a female

Patient-reported outcomes for children with anorectal malformation

Rectoperineal fistula in a female

Before this study, little has been documented about how anorectal malformation type, sacral ratio, age and bowel regimen affect continence and quality of life.

A large, multi-institutional study including patient-reported outcomes for children who have anorectal malformations found that the type of malformation and whether a child is clean/continent and not soiling can have a significant impact on the assessment of a patient’s quality-of-life. The study also highlights that patients and their families seem to benefit from access to a specialized center offering multi-disciplinary care in a single location.

What it means

The study is one of the first to collect input from patients and their families at two multi-disciplinary centers for colorectal care. The authors, including Marc Levitt, MD, chief of Colorectal and Pelvic Reconstruction at Children’s National Hospital, who collaborated with colleagues at Nationwide Children’s Hospital in Columbus and Royal Children’s Hospital in Melbourne Australia, sought to understand the impact of the anorectal malformation type and the development of the sacrum bone on continence outcomes in children. Additionally, the team aimed to compare continence outcomes by age group and determine the quality of life with different bowel regimens, including medications like laxatives or the use of enemas.

The researchers found that continence in patients taking laxatives to manage their bowels varied depending on the type of malformation, but that sacral ratio or a measure of the growth of a key pelvic bone correlating with pelvic floor development, did not seem to play a role in continence.

Additionally, patients (and patient families) had similar perceptions of their overall quality of life, as long as the child was clean/continent. Quality-of-life scores were lower, however,  if a child was managed using enemas but continued to experience soiling/incontinence. This vital component was a measure of patient reported outcomes, or how the patient perceives their care is going.

Why it matters

Before this study, little has been documented about how anorectal malformation type, sacral ratio, age and bowel regimen affect continence and quality of life. For the first time, these reports are coming from the patient and family point of view. In their conclusion, the authors note that the study’s findings provide important discussion points for counseling patients on long term management strategies for children with anorectal malformations. The findings also identify new areas for research driven by what patients and their families report are most important.

Read the full study, Patient-reported outcomes of Children with an Anorectal Malformation in the Annals of Surgery.

ARM index webinar

Colorectal team presents virtual conference sessions

The 6th Annual Alex Pediatric Surgery Congress and 1st Nile of Hope Hospital Congress conference, in cooperation with Colorectal Team Overseas (CTO), provides updates in colorectal, urogenital disorders and pelvic reconstructions in pediatrics. The Children’s National Hospital colorectal team was due to present at the conference in Alexandria, Egypt, in April 2020, but due to the global COVID-19 pandemic the event was indefinitely postponed. Despite this, Marc Levitt, M.D., Colorectal and Pelvic Reconstructive Surgeon at Children’s National, and Founder and Head of the CTO, presented educational sessions virtually to Egyptian surgeons throughout the month of April.

Anorectal malformation case presentation

Surgeons assemble in a virtual Zoom session for a case presentation on anorectal malformations by Marc Levitt, M.D., and the Children’s National colorectal team.

The video conferences allowed surgeons and experts to come together and foster the global collaboration that benefits colorectal teams and patients worldwide. The first session included 70 pediatric surgeons from Egypt and grew to over 128 attendees in the last session. The presentations spanned a variety of topics and can be accessed at the links below:

Joining Dr. Levitt in the discussion were members of the Children’s National colorectal nursing team, including Julie Choueiki, Program Manager, Justine Garofalo, CPNP, Meghan Mesa, Tara Garbarino, CPNP, and Katherine Worst, CPNP-AC. The integrated Children’s National colorectal team elevates the significance of the nursing role in caring for complex patients. For example, cases in the Bowel Management Program require hours of ongoing nursing care. The team demonstrated the partnership that benefits children when surgeons include and value nursing presence in the care of colorectal patients.

Moving forward, the team will bring continued virtual, telehealth collaboration and education. Doing so will expand the potential for more colorectal patients to receive the care they need.