Pediatric Surgical Care of Anorectal Malformations: A Global Survey

Abstract Purpose All patients born with anorectal malformations (ARMs) deserve high-quality healthcare, including appropriate neonatal screening, perioperative management, and long-term follow-up. This study examined global pediatric surgical practices for ARM management, identifying areas of consensus and variability in perioperative care and reported outcomes. Methods A multi-center survey distributed by The Hendren Project (a global networked community of pediatric surgeons) invited surgeons to retrospectively review their ten most recent primary ARM reconstructions, excluding reoperations. Data were compared by country/continent and World Bank income. Results A total of 144 surgeons from 90 hospitals in 50 countries reported outcomes for 900 patients. Sacral radiographs were inconsistently obtained, with 34.2% lacking lateral views and 21.9% missing anterior-posterior views. The complication rate after PSARP was 27.2%, including dehiscence (11.7%), wound infection (7.4%), and stricture (6.9%). Divided stomas were more common than loop colostomies (66.3% versus 28.8%). Postoperative anal dilations were performed by 92.6% of surgeons. Reported complication rates did not differ significantly by region or income category. Conclusion This global survey demonstrates wide regional and income-based variability in ARM perioperative care, spanning screening, operative strategy, timing, and postoperative management. Inconsistent sacral and spinal screening, especially in low-resource settings, highlights needs for standardized pathways and context-aware quality improvement efforts worldwide.