The impact of perioperative care on complications and short term outcome in ARM type rectovestibular fistula: An ARM-Net consortium study

Research output: Contribution to journalArticle


Background: The impact of perioperative care interventions on postreconstructive complications and short-term colorectal outcome in patients with anorectal malformation (ARM) type rectovestibular fistula is unknown. Methods: An ARM-Net consortium multicenter retrospective cohort study was performed including 165 patients with a rectovestibular fistula. Patient characteristics, perioperative care interventions, timing of reconstruction, postreconstructive complications and the colorectal outcome at one year of follow-up were registered. Results: Overall complications were seen in 26.8% of the patients, of which 41% were regarded major. Differences in presence of enterostomy, timing of reconstruction, mechanical bowel preparation, antibiotic prophylaxis and postoperative feeding regimen had no impact on the occurrence of overall complications. However, mechanical bowel preparation, antibiotic prophylaxis ≥ 48 h and postoperative nil by mouth showed a significant reduction in major complications. The lowest rate of major complications was found in the group having these three interventions combined (5.9%). Multivariate analyses did not show independent significant results of any of the perioperative care interventions owing to center-specific combinations. At one year follow-up, half of the patients experienced constipation and this was significantly higher among those with preoperative mechanical bowel preparation. Conclusions: Differences in perioperative care interventions do not seem to impact the incidence of overall complications in a large cohort of European rectovestibular fistula-patients. Mechanical bowel preparation, antibiotic prophylaxis ≥ 48 h, and postoperative nil by mouth showed the least major complications. Independency could not be established owing to center-specific combinations of interventions. Type of study: Treatment study. Level of evidence: III


  • H. J.J. van der Steeg
  • I. A.L.M. van Rooij
  • B. D. Iacobelli
  • C. E.J. Sloots
  • E. Leva
  • P. Broens
  • F. Fascetti Leon
  • I. Makedonsky
  • E. Schmiedeke
  • A. García Vázquez
  • P. Midrio
  • G. Lisi
  • E. Amerstorfer
  • M. Miserez
  • M. Fanjul
  • J. Ludwiczek
  • P. Stenström
  • S. Giuliani
  • A. F.W. van der Steeg
  • I. de Blaauw
  • ARM-Net consortium
External organisations
  • Bambino Gesù Children’s Hospital
  • Maggiore Hospital Policlinico
  • University Medical Center Groningen
  • University of Padova
  • Klinikum Bremen-Mitte
  • 12 de Octubre University Hospital
  • University of Chieti-Pescara
  • Medical University of Graz
  • University Hospitals Leuven
  • St George's Hospital, London
  • Amsterdam UMC - Vrije Universiteit Amsterdam
  • Radboud University Medical Center
  • Erasmus University Medical Center
  • Dnipropetrovsk Oblast Children's Hospital
  • Treviso Hospital
  • Civic Hospital Of Pescara
  • Hospital Gregorio Maranon
  • Kepler Universitätsklinikum
  • Skåne University Hospital
  • Emma Children’s Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Pediatrics
  • Surgery


  • Anorectal malformation (ARM), Antibiotic prophylaxis, Complications, Mechanical bowel preparation, Perioperative care, Postoperative feeding regimen
Original languageEnglish
Pages (from-to)1595-1600
JournalJournal of Pediatric Surgery
Issue number8
Early online date2019 Mar 21
Publication statusPublished - 2019
Publication categoryResearch