Quick Literature Updates Episode 14

The study by Ahmad et al. examined 384 females with anorectal malformations using the Pediatric Colorectal and Pelvic Learning Consortium database.

About 27% of patients with anorectal malformations had a gynecologic anomaly.

About 46% of females with anorectal malformations had VACTERL association, defined as having the anorectal malformation plus two of: vertebral, cardiac, tracheoesophageal, renal, or limb anomaly.

Having VACTERL association was associated with more gynecologic anomalies compared to patients without VACTERL association.

The association between VACTERL and gynecologic anomalies was especially true when renal anomalies were found.

The association between VACTERL and gynecologic anomalies was especially true when patients had recto vestibular or rectal perineal fistulas.

For females with anorectal malformations and VACTERL association, especially renal anomalies, clinicians should look carefully for gynecologic anomalies.

Thoracic epidural and intercostal nerve cryoablation are two options for pain control in patients undergoing a Nuss procedure for pectus excavatum.

Dr. Tsai and his team from Penn State conducted a retrospective chart review of kids who underwent Nuss procedure between 2002 and 2020, comparing outcomes and costs of intercostal nerve cryoablation and epidural.

The intercostal nerve cryoablation group had lower rates of PCA use compared to thoracic epidural.

The intercostal nerve cryoablation group had lower total morphine milligram equivalent requirement compared to thoracic epidural.

The intercostal nerve cryoablation group had shorter length of stay in the hospital compared to thoracic epidural.

The intercostal nerve cryoablation group had longer operative times compared to thoracic epidural.

The intercostal nerve cryoablation group had higher total hospitalization cost compared to thoracic epidural.

Both intercostal nerve cryoablation and thoracic epidural have pros and cons, with cryoablation showing decreased total opioid use and decreased length of stay but increased operating room times and increased total cost.

The Bokova et al. study is a multi-institutional one-year outcome study of anal sphincter reconstruction for patulous sphincter in 6 patients.

Of the 6 patients in the sphincter reconstruction study, 2 had Down syndrome and underwent redo pull-through with anal sphincter reconstruction.

Four patients in the sphincter reconstruction study received only anal sphincter reconstruction without redo pull-through.

The 4 patients who received only anal sphincter reconstruction achieved voluntary bowel movements with higher productivity and confidence.

Anal sphincter reconstruction appears to be an option for overstretched anal sphincters in patients with Hirschsprung disease after a pull-through.