European consensus meeting of ARM-Net members concerning diagnosis and early management of newborns with anorectal malformations

Abstract

The ARM-Net (anorectal malformation network) consortium held a consensus meeting in which the classification of ARM and preoperative workup were evaluated with the aim of improving monitoring of treatment and outcome. The Krickenbeck classification of ARM and preoperative workup suggested by Levitt and Peña, used as a template, were discussed, and a collaborative consensus was achieved. The Krickenbeck classification is appropriate in describing ARM for clinical use. The preoperative workup was slightly modified. In males with a visible fistula, no cross-table lateral X-ray is needed and an anoplasty or (mini-) posterior sagittal anorectoplasty can directly be performed. In females with a small vestibular fistula (Hegar size <5 mm), a primary repair or colostomy is recommended; the repair may be delayed if the fistula admits a Hegar size >5 mm, and in the meantime, gentle painless dilatations can be performed. In both male and female perineal fistula and either a low birth weight (<2,000 g) or severe associated congenital anomalies, prolonged preoperative painless dilatations might be indicated to decrease perioperative morbidity caused by general anesthesia. The Krickenbeck classification is appropriate in describing ARM for clinical use. Some minor modifications to the preoperative workup by Levitt and Peña have been introduced in order to refine terminology and establish a comprehensive preoperative workup.

Fig. 1

Neonatal workup of male patients as suggested by Levitt and Peña [2]. PSARP posterior sagittal anorectoplasty

Fig. 2

Neonatal workup of male patients suggested by anorectal malformation (ARM)-Net. PSARP posterior sagittal anorectoplasty

Fig. 3

Neonatal workup of female patients as suggested by Levitt and Peña [2]. US ultrasound

Fig. 4

Neonatal workup of female patients suggested by anorectal malformation (ARM)-Net