Original articlePreliminary report on the International Conference for the Development of Standards for the Treatment of Anorectal Malformations
Section snippets
International classification of anorectal malformations
The most common previous international classification was referred to as the Wingspread classification of anorectal malformations, elaborated in Wingspread, Wis, in 1984 [1] (Fig. 2). This classification distinguished between high, intermediate, and low anomalies in the male and female, with special groups established for cloacal and rare malformations. High-type anorectal malformations were subdivided into anorectal agenesis with and without fistula, and rectal atresia. The intermediate
International grouping of operative procedures
The Krickenbeck study group decided that, for follow-up studies, not only the site of the fistula should be documented but also an additional grouping according to the operative procedure performed is necessary. The operative procedures are listed in Table 3 as follows: perineal operation, anterior sagittal approach, sacroperineal procedure, PSARP, abdominosacroperineal pull-through, abdominoperineal pull-through, and laparoscopic-assisted pull-through.
International classification for follow-up assessment
After the introduction of the PSARP by Peña [3] and De Vries [4], the major postoperative problem observed was motility disturbances leading to chronic constipation and overflow incontinence, and true sphincter insufficiency with stool incontinence was much less of a problem than was observed in the past [6]. Therefore, after repair, we have to consider 2 different clinical outcomes that must be distinguished from one another to start appropriate therapy: chronic constipation and stool
Conclusions
The participants of the Krickenbeck conference aimed to develop standards for the treatment of anorectal malformations and hope that these 3 new groupings and/or classifications will permit comparison of postoperative results in different centers of pediatric surgery internationally. This will be of great value for children with anorectal agenesis as well as the surgeons that care for them. The final results of the Krickenbeck conference will be published by Springer International Publishers in
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