OBJECTIVE: Establishing the incidence and types of complications following surgical intervention for ARM, primarily after reconstruction. Patient- and treatment-related risk factors were also determined. BACKGROUND: Postoperative complications of ARM surgery vary widely, with data predominantly derived from single-center retrospective studies with limited number of patients. Whether factors such as ARM type, associated congenital anomalies, prior enterostomy, or type of reconstructive surgery affect complication incidence remains unclear. METHODS: This multicenter cohort study was performed using the ARM-Net registry with prospectively collected data. Enterostomy-related and post-reconstructive complications in patients who underwent reconstructive surgery before the age of five years were recorded. Patients with more than 25 % missing data, unknown sex, ARM type, or reconstruction date, or without (information on) reconstruction or complications, were excluded. Multivariable analyses identified independent risk factors for the development of complications. RESULTS: A total of 2,043 patients were eligible for analysis. Complications after enterostomy formation and closure occurred in 25 % and 12 % of patients, respectively. Post-reconstructive complications occurred in 25 % of patients, with wound complications comprising half of the complications. In a multivariable analysis, recto-bladder neck fistula, any associated anomaly, and the LAARP procedure were identified as independent risk factors for post-reconstructive complications. In contrast, anoplasty and mini-PSARP reduce the risk of complications. CONCLUSIONS: Post-reconstructive complications in ARM patients are common, and certain patient- and treatment-related characteristics affect postoperative outcomes. These results aid counselling and clinical decision-making, and may guide the operative planning of ARM types that are amenable to several different surgical approaches.

Department for Health Evidence Radboudumc Nijmegen the Netherlands

Department of Child and Adolescent Psychiatry and Psychotherapy University Medical Center of Johannes Gutenberg University Mainz Germany; Department of Medicine Faculty of Health Witten Herdecke University Witten Germany

Department of Pediatric and Adolescent Surgery Medical University of Graz Austria

Department of Pediatric Surgery and Urology Centre for Child and Youth Health Klinikum Bremen Mitte Bremen Germany

Department of Pediatric Surgery Erasmus Medical Center Sophia Children's Hospital Rotterdam the Netherlands

Department of Pediatric Surgery Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy

Department of Pediatric Surgery Hospital Gregorio Marañón Madrid Spain

Department of Pediatric Surgery Radboudumc Amalia Children's Hospital Nijmegen the Netherlands

Department of Pediatric Surgery Radboudumc Amalia Children's Hospital Nijmegen the Netherlands; Surgical Research Murdoch Children's Research Institute Melbourne Australia

Department of Pediatric Surgery Schneider Children's Medical Center Faculty of Medicine Tel Aviv University Tel Aviv Israel

Department of Pediatrics Clinical Sciences Lund University Skane University Hospital Lund Sweden

Medical and Surgical Department of the Fetus Newborn Infant Ospedale Bambino Gesù Rome Italy

Pediatric Surgery Unit Cà Foncello Hospital Treviso Italy

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