Special Aspects of Anorectal Pediatric Surgery
Pediatric colorectal surgery is an important part of specialized pediatric surgery. Many children with colorectal problems have impaired long-term function that requires adequate follow-up and management to avoid psychosocial consequences. Research has often focused on Hirschsprung's disease, anorectal malformations, and inflammatory bowel disease. There are recent guidelines to provide high quality, standardized care for these patient groups.  On the other hand, there are several common anorectal conditions that are less often recognized in the literature. For instance, searching PubMed for “Hirschsprung's disease” results in 6,272 abstracts, whereas a search for “anal AND fissure AND child*” results in 217 abstracts. The purpose of this review block was to give an overview of current management of some of the most common anorectal conditions in children.
Vilanova-Sánchez and Levitt provide a comprehensive update on the role of surgical approaches for functional constipation in children. Conservative measures are the first-line treatment, but surgical management is occasionally an option for children who fail nonoperative treatment.
Mutanen and Pakarinen show that biological agents have improved the outcomes and reduced the need for major surgical interventions in children and adolescents with perianal Crohn's disease. Individualized, multidisciplinary management is recommended and the management of perianal Crohn's disease in adolescents usually follow adult recommendations.
Mc Guire and Dickie discuss the vascular lesions of the colon and rectum that are often challenging to treat and require a multidisciplinary approach to ensure the best possible outcome.
Saadai et al describe that anal prolapse resolves spontaneously in most children, although sclerotherapy or surgical intervention is occasionally required. It remains unclear which is the optimal sclerosing agent, as well as the best surgical approach, for these children.
Gosemann and Lacher review the literature on perianal abscess and fistula-in-ano, which is usually a self-limiting condition in infants. A nonoperative approach should be the first-line treatment, whereas surgery is occasionally indicated if nonoperative management fails.
Patkova and Wester update the knowledge of anal fissure in children. Most fissures heal with general conservative management, whereas occasionally nonoperative measures, such as topical glyceryl trinitrate or calcium channel blockers or botulinum toxin injection treatment, are required.
For most of these conditions, there are limited data to compare different nonoperative and surgical interventions. These articles show that there are wide knowledge gaps in pediatric colorectal surgery. We hope that this review block will support the readers in their management of children with colorectal problems and also stimulates to set up well-designed studies that fill some of the knowledge gaps. There are a lot of opportunities for research in this area.
07 October 2020 (online)
© 2020. Thieme. All rights reserved.
Georg Thieme Verlag KG
Stuttgart · New York
- 1 Kyrklund K, Sloots CEJ, de Blaauw I. , et al. ERNICA guidelines for the management of rectosigmoid Hirschsprung's disease. Orphanet J Rare Dis 2020; 15 (01) 164
- 2 Turner D, Ruemmele FM, Orlanski-Meyer E. , et al. Management of paediatric ulcerative colitis, part 1: ambulatory care – an evidence-based guideline from European Crohn's and Colitis organization and European Society of Paediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 2018; 67 (02) 257-291