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Long-term outcomes of cloacal malformations remain unclear. We evaluated postoperative bowel control, bladder function and quality of life in patients under 18 years of age with cloaca. This was a multi-center cross-sectional observational study accomplished by the Nordic Pediatric Surgery Research Consortium. Patients with a cloacal malformation, 4–17 years of age, were eligible. Data including patient characteristics, surgical procedures, and complications were retrieved from case records. Established questionnaires with normative control values evaluating bowel function, bladder function, and health-related quality of life (HRQoL) were sent to the patients and their caregivers. The study was approved by the participating center's Ethics Review Authorities. Twenty-six (67%) of 39 eligible patients with median age 9.5 (range, 4–17) years responded. Twenty-one (81%) patients had a common channel ≤3 cm. Imaging confirmed sacral anomalies in 11 patients and spinal cord abnormalities in nine. Excluding patients with stoma (n = 5), median bowel function score was 12 [7-19], and 5 patients (20%) reported a bowel function score ≥17, approaching normal bowel control level. Bowel management increased proportion of socially continent school-aged children to 52%. Six (23%) patients had a permanent urinary diversion or used clean intermittent catheterization (CIC), while majority (70%) of the remaining patients were urinary continent. The reported HRQoL was comparable to healthy Swedish children. Whilst well-preserved spontaneous bowel control was rare, a majority of patients were dry for urine without any additional procedures. Few patients experienced social problems or negative impact on HRQoL due to bladder or bowel dysfunction. Level IV. • What is currently know about this topic? • Cloacas are complex malformations that require reconstructive surgical procedures and have a negative impact on bowel and bladder function. • What new information is contained in this article? • Most children with cloacal malformations have impaired bowel control, which improves with increasing age. A large proportion of patients need a permanent stoma or use antegrade enemas to stay clean. • The impaired bowel and bladder function has limited impact on health-related quality of life. [ABSTRACT FROM AUTHOR]

Children with long-gap esophageal atresia (LGEA) face a high risk of digestive and respiratory morbidity, but their mental health outcomes have not been investigated. We aimed to identify the prevalence of mental health problems in children with LGEA, associated factors and health-related quality of life (HRQOL). Twenty-six children with LGEA aged 3–17 were recruited nationwide in Sweden. One of their parents and adolescents aged 11–17 completed information on the child's mental health (Strength and Difficulties Questionnaire), generic (PedsQL 4.0) and condition-specific HRQOL (EA-QOL). Parents gave information on current child symptomatology. Mental health level was determined using validated norms; abnormal≥90 percentile/borderline≥80 percentile/normal. Elevated levels were considered borderline/abnormal. Data were analyzed using descriptives, correlation and Mann-Whitney-U test. Significance level was p < 0.05. Twelve children with LGEA aged 3–17 (46%) had elevated scores of ≥1 mental health domain in parent-reports, whereas 2 adolescents (15%) in self-reports. In parent-reports, 31% of the children had elevated levels of peer relationship problems, with associated factors being child sex male (p = 0.037), airway infections (p = 0.002) and disturbed night sleep (p = 0.025). Similarly, 31% showed elevated levels of hyperactivity/inattention, and associated factors were male sex (p = 0.005), asthma (p = 0.028) and disturbed night sleep (p = 0.036). Elevated levels of emotional symptoms, seen in 20%, were related to swallowing difficulties (p = 0.038) and vomiting problems (p = 0.045). Mental health problems correlated negatively with many HRQOL domains (p < 0.05). Children with LGEA risk mental health difficulties according to parent-reports, especially peer relationship problems and hyperactivity/inattention, with main risk factors being male sex, airway problems and sleep disturbances. This should be considered in follow-up care and research, particularly since their mental health problems may impair HRQOL. Prognosis study, LEVEL II. • What is currently known about this topic? • Children with long-gap esophageal atresia (LGEA) face a high risk of digestive morbidity, malnutrition and lung impairments. • What new information is contained in this article? • Children with LGEA-especially boys, those with airway problems and sleep disturbances-risk mental health problems. • Their mental health difficulties may impair health-related quality of life. [ABSTRACT FROM AUTHOR]

Despite advances in the management of short bowel syndrome related intestinal failure (SBS-IF), large-scale contemporary pediatric studies are scarce. The aim of this multicenter study was to assess key outcomes and clinical prognostic factors in a recent Nordic pediatric SBS-IF population. Patients with SBS-IF treated during 2010–2019, whose parenteral support (PS) started at age <1 year and continued >60 consecutive days were included and retrospectively reviewed. All six participating centers followed multidisciplinary SBS-IF management. Risk factors for PS dependency, intestinal failure associated liver disease (IFALD) and mortality were assessed with Cox regression and Kaplan Meier analyses. IFALD was defined with serum liver biochemistry levels. Among 208 patients, SBS-IF resulted from NEC in 49%, gastroschisis w/wo atresia in 14%, small bowel atresia in 12%, volvulus in 11%, and other diagnoses in 14%. Median age-adjusted small bowel length was 43% (IQR 21–80%). After median follow up of 4.4 years (IQR 2.5–6.9), enteral autonomy was reached by 76%, none had undergone intestinal transplantation, and overall survival was 96%. Half of deaths (4/8) were caused by septic complications. Although biochemical cholestasis occurred only in 3% at latest follow-up and none of deaths were directly caused by IFALD, elevated liver biochemistry (HR 0.136; P = 0.017) and shorter remaining small bowel (HR 0.941; P = 0.040) predicted mortality. Shorter remaining small bowel and colon, and presence of end-ostomy were the main predictors of PS dependency, but not IFALD. Patients with NEC reached enteral autonomy more efficiently and had decreased incidence of IFALD compared to other etiologies. Although with current multidisciplinary management, prognosis of pediatric SBS is encouraging, septic complications and IFALD still associated with the remaining low mortality rate. [ABSTRACT FROM AUTHOR]

• Anorectal malformations (ARM) cover a spectrum of heterogenous congenital conditions. Current ARM follow-up programs do not address issues of postoperative scarring nor provide guidelines for scar treatment. Increased knowledge about postoperative scarring and its physical and psychosocial significance is needed urgently. • In our study of 27 ARM patients, six participants (22%) reported recurrent scar pain and five (19%) scar pruritus. Nine participants (33%) reported altered behavior. Eight participants (30%) requested scar treatment, mainly for estethic reasons. Scar formation prevention should be highlighted for every surgeon in reducing postoperative scar morbidity. Background Abdominal scarring in patients with anorectal malformations (ARM) is a permanent visible sign of a chronic congenital condition. The study's aims were to assess the physical and psychosocial significance of abdominal scarring in ARM and to propose a scar treatment approach. Methods A patient- and observer reported cross-sectional study of ARM patients with previous colostomies surgically treated 1997–2015 with minimum 4 years' follow-up after stoma closure. A maximum of 3 patient-selected scars per patient were evaluated by a) the Patient and Observer Scar Assessment Scale (POSAS; 11= no symptoms, 110=worst symptoms), b) pictorial scar treatment assessment by a plastic surgeon, c) questionnaire evaluation of the scarring's psychosocial aspects, bowel- and urinary function and quality of life. Descriptive statistics were presented in median (range) and percent (%), and Pearson's r was used to evaluate linear correlations. Ethical approval and written consents were obtained. Results Twenty-seven patients (48% females) aged 12 (5–24) years old were included. Two (1–3) scars were evaluated per patient with a median POSAS score of 44 (15–78). Six patients (22%) reported scar pain, five (19%) scar pruritus and nine (33%) affected behavior, e.g. always wearing full-covered clothing in public places. Higher (worse) POSAS score and increasing age correlated (r = 0.40, p = 0.04). According to the plastic surgeon's assessment, 21 patients (78%) were suitable candidates for surgical scar treatment, among whom eight patients (30%) requested scar treatment. Conclusions Postoperative abdominal scarring should require attention in clinical ARM follow-up programs including potential corrective plastic surgery for selected patients. [ABSTRACT FROM AUTHOR]

Outcome of patients operated for anorectal malformation (ARM) type rectovestibular fistula (RVF) is generally considered to be good. However, large multi-center studies are scarce, mostly describing pooled outcome of different ARM-types, in adult patients. Therefore, counseling parents concerning the bowel function at early age is challenging. Aim of this study was to evaluate bowel function of RVF-patients at preschool/early childhood age and determine risk factors for poor functional outcome. A multi-center cohort study was performed. Patient characteristics, associated anomalies, sacral ratio, surgical procedures, post-reconstructive complications, one-year constipation, and Bowel Function Score (BFS) at 4–7 years of follow-up were registered. Groups with below normal (BFS < 17; subgroups 'poor' ≤ 11, and 'fair' 11 < BFS < 17) and good outcome (BFS ≥ 17) were formed. Univariable analyses were performed to detect risk factors for outcome. The study included 111 RVF-patients. Median BFS was 16 (range 6–20). The 'below normal' group consisted of 61 patients (55.0%). Overall, we reported soiling, fecal accidents, and constipation in 64.9%, 35.1% and 70.3%, respectively. Bowel management was performed in 23.4% of patients. Risk factors for poor outcome were tethered cord and low sacral ratio, while sacral anomalies, low sacral ratio, prior enterostomy, post-reconstructive complications, and one-year constipation were for being on bowel management. Although median BFS at 4–7 year follow-up is nearly normal, the majority of patients suffers from some degree of soiling and constipation, and almost 25% needs bowel management. Several factors were associated with poor bowel function outcome and bowel management. Level III. [ABSTRACT FROM AUTHOR]

Genital malformations are frequently diagnosed in patients with VACTERL, but are currently not included in the acronym. This study aimed to analyze the frequency of genital anomalies in patients with esophageal atresia (EA) and/or anorectal malformation (ARM), with a subgroup analysis of children fulfilling the VACTERL criteria. This was a cross-sectional retrospective analysis of two prospectively collected registries of patients operated on for ARM and EA between 2012 and 2022 at a specialized national center. Children were screened routinely for malformations according to the VACTERL acronym. A total of 174 children were included in the study. VACTERL was diagnosed in 60 children (34%), while 114 children (66%) were defined as non-VACTERL. Genital malformations were diagnosed in 38% (23/60) of the children with VACTERL, and in 11% (13/114) of the children without VACTERL (p < 0.001). The presence of genital malformations correlated linearly with the number of diagnosed component features (CFs). In boys with VACTERL, the most common genital malformation was undescended testes present in 10/27 (21%) compared to 1/71 (1%) in non-VACTERL boys (p < 0.001). Müllerian duct anomalies were found in 26% of girls with VACTERL vs. 7% in non-VACTERL girls (p < 0.05). There was a higher frequency of genital malformations in patients with VACTERL emphasizing the importance of genital assessment for these patients. We propose VACTERL-G as an extension of the current acronym aiming to reduce the risk of long-term morbidity due to delayed diagnosis of reproductive anomalies. 4. • Genital malformations are diagnosed frequently in patients with VACTERL. • The frequency of genital malformations is directly correlated with the number of diagnosed VACTERL component features. We propose VACTERL-G as an extension of the acronym to increase awareness of genital malformations and reduce the risk of long-term morbidity. [ABSTRACT FROM AUTHOR]

Primary surgery for vulvar cancer has become less radical in past decades. This study investigates risk factors and prevalence of short-and long-term complications after up-to-date vulvar cancer surgery. Population-based cohort study of surgically treated primary vulvar cancer at a national center of vulvar cancer, assessing surgical outcome. The Swedish Quality Registry for Gynecological Cancer was used for identification, journals reviewed and surgical outcome including complications within 30 days and one year registered. Multivariable logistic regression analysis comprising risk factors of short-term complications; age>80 years, BMI, smoking, diabetes, lichen sclerosus and FIGO stage was performed. 182 patients were identified, whereas 55 had vulvar surgery only, 53 surgery including sentinel lymph node biopsy (SLNB) and 72 surgery including inguinofemoral lymphadenectomy (IFL), with short-term complication rates of 21.8%, 39.6% and 54.2% respectively. Vulvar wound dehiscence was reported in 6.0% and infection in 13.7%. Complication rates were lower after SLNB than IFL (wound dehiscence 0% vs 8.3%; p = 0.04, infection 15.1% vs 36.1%; p = 0.01 and lymphocele 5.7% vs 9.7%; p = 0.52). Severe complications were rare. Persisting lymphedema evolved in 3.8% after SLNB and in 38.6% after IFL (p = 0.001), ubiquitous after adjuvant radiotherapy. In multivariable regression analysis, no associations between included risk factors and complications were found. Surgical complications are still common in vulvar cancer surgery and increase with the extent of groin surgery. To thrive for early diagnosis and to avoid IFL seem to be the most important factors in minimizing short-and long-term complications. [ABSTRACT FROM AUTHOR]

The emergence and spread of antibiotic resistance through insufficiently treated effluents from wastewater treatment systems are detrimental to the receiving environment and human health. Metagenomic and transcriptomic approaches were employed to assess the diversity and the removal of bacterial pathogens, antibiotic-resistant genes (ARGs) and mobile genetic elements (MGEs) in three wastewater treatment plants (WWTPs) in Durban, South Africa. In total, 23 pathogenic bacterial genera, including enteric and emerging opportunistic pathogens, were found abundant in the samples. Aeromonas and Acinetobacter spp were the most dominant pathogens detected in the influent metagenomes, while the influent transcripts showed Escherichia and Acinetobacter spp as the most dominant pathogens. Shannon-Wiener indices showed that the bacterial diversity increased from influents to final effluents in two selected treatment plants. ARG types, including those conferring resistance to aminoglycosides, beta-lactamases, tetracycline and sulfonamide were abundant in both influent and effluent samples. Results further exposed that MGE-ARGs associations were the main drivers of ARG persistence into final effluents. This included 5 plasmids: R338-R151 (sulI), pRH-1238 (strB), pPM91 (aadA), pRH-1238 (aadA4–5), pRH-1238 (sulII); two class 1 integrons (aadA and arr) and 1 transposon Tn4351(tetX). In transcripts, MGE-ARG association showed two plasmids: pRH-1238 (aadA) and pPM91(aadA) and one hybrid plasmid R338-R151 (sulI). It was apparent across all the WWTPs that chlorination had little or no effect on MGE-ARG association. Combined, this study has highlighted the presence of bacterial pathogens, ARGs and MGEs in treated effluents, which can encourage the propagation of antibiotic resistance and potential sharing of genes in the downstream environments. [Display omitted] • Metagenomic and transcriptomic profiling of pathogens and antibiotic resistant genes and MGEs in wastewater in South Africa. • Aeromonas and Acinetobacter spp were the most dominant pathogens detected in the influent metagenomes. • Escherichia and Acinetobacter were the most abundant in the trsncripts. • Antibiotic resistant genes aaminoglycosides, beta-lactamases, tetracycline and sulfonamide were the most abundant. • Chlorination has little or no effect on MGE-ARG association was apparent across all WWTPs. [ABSTRACT FROM AUTHOR]

Aim: There is a knowledge gap regarding which patients with anorectal malformations (ARMs) are at highest risk of anorectal prolapse (AP), and which risk factors predispose to AP in ARM. The aims of the study were to define the frequency of AP after ARM reconstruction, and explore risk factors., Method: Data from the ARM-Net registry inserted between 2007 and 2023 were used. Inclusion criteria were the reconstruction performed, no stoma at 1-year follow-up and all data available at 1-year follow-up. The statistics used were univariable and multivariable logistic regression models., Results: After exclusions the incidence of AP was 163 in 1117 patients (14.6%) in data inserted by 31 centres from 12 countries. The AP incidence was unevenly distributed between the centres (interquartile range 6.3%-21.7%). AP was more frequent in boys than girls (20.9% vs. 8.1%; P < 0.001). In both sexes the incidence of AP was higher in complex ARM subtypes (P < 0.001). AP was most frequent after laparotomy- and laparoscopic-assisted reconstructions (50.0% and 37.5%, respectively). Spinal and sacral anomalies constituted risk factors for AP in univariable analyses, while tethered cord did not. Adjusted risk factors for AP were severity of ARM subtype (40% in long-channel cloaca and bladder neck fistula, OR 3.1, 95% CI 1.0-10.2), laparotomy-assisted posterior sagittal anorectoplasty (50%, OR 3.7, 95% CI 1.6-8.4) and larger neo-anus at 1-year follow-up (Hegar 13.6 vs. 13.1; OR 1.2, 95% CI 1.1-1.4). Constipation was not a risk factor for AP., Conclusion: Anorectal prolapse is a frequent postoperative sequela. Adjusted analyses indicate that severity of ARM, abdominal open access during reconstruction and larger size of anus are risk factors., (© 2025 The Author(s). Colorectal Disease published by John Wiley & Sons Ltd on behalf of Association of Coloproctology of Great Britain and Ireland.)

Introduction:  Being born with an anorectal malformation (ARM) can have profound and lifelong implications for patients and parents. Organization of care and communication between health care providers is an overlooked area of patient care. The European Reference Network eUROGEN for rare and complex urogenital conditions assembled a panel of experts to address these challenges and develop comprehensive guidelines for the management of ARM., Methods:  The Dutch Quality Standard for ARM served as the basis for the development of guidelines. Literature was searched in Medline, Embase, and Cochrane. The ADAPTE method was utilized to incorporate the newest available evidence. A panel of 15 experts from seven European countries assessed currency, acceptability, and applicability of recommendations. Recommendations from the Dutch Quality Standard were adapted, adopted, or rejected and recommendations were formed considering all available evidence, expert consensus, and the European context., Results:  Aspects pertaining to organization of care, patient/parent/health care provider communication, and referral and collaboration between providers caring for ARM patients were assessed. Two new studies were identified. In total, the panel adapted 12 recommendations, adopted 7, and developed 2 de novo. The overall level of newly found evidence was considered low and most recommendations were based on expert opinion., Conclusion:  Collaborative care and organization of care are gaining importance in the field of ARM. This guideline gives practical guidance on how to achieve better communication and collaboration between all involved parties, applicable at the European level., Competing Interests: We would like to disclose that two of the authors of this adaptation report (I.D.B., C.S.) were also authors of the Dutch Quality Standard. However, it is important to note that neither I.D.B. nor C.S. has any conflict of interest to declare and they did not advocate for any particular viewpoints or positions in relation to the content of the Dutch Quality Standard. No conflicting interests were declared from the other authors., (Thieme. All rights reserved.)

Introduction:  Anorectal malformations (ARMs) are rare congenital anomalies that involve the anus, rectum, and oftentimes the genitourinary tract. The management of ARM patients is complex, and many controversies exist. To address this issue, the European Reference Network eUROGEN for rare and complex urogenital conditions aimed to develop comprehensive guidelines for the management of ARM., Methods:  The Dutch Quality Standard for ARM served as the basis for the development of guidelines applicable on a European level. Literature was searched in Medline, Embase, and Cochrane. The ADAPTE method was utilized to incorporate the newest available evidence. A panel of 15 experts from 7 European countries assessed currency, acceptability, and applicability of recommendations. Recommendations from the Dutch Quality Standard were adapted, adopted, or rejected, and recommendations were formed considering current evidence and/or expert consensus., Results:  Prenatal and neonatal diagnostic workup as well as postsurgical follow-up of anorectal, genitourinary tract, and neurologic system were reviewed. Seven new studies were identified. The panel adapted 13 recommendations, adopted 7, and developed 8 de novo. The availability of high-quality evidence was limited, and most recommendations were based on retrospective studies, case series, or expert opinion., Conclusion:  Patients with ARM and their families require highly specialized and comprehensive care from the prenatal period to adulthood. This guideline provides recommendations for a comprehensive diagnostic workup of children with ARM throughout their life that is applicable on a European level., Competing Interests: We would like to disclose that two of the authors of this adaptation report (I.D.B., C.E.J.S.) were also authors of the Dutch Quality Standard. However, it is important to note that neither I.D.B. nor C.E.J.S. has any conflict of interest to declare and they did not advocate for any particular viewpoints or positions in relation to the content of the Dutch Quality Standard. No conflicting interests were declared from the other authors., (Thieme. All rights reserved.)

Introduction:  Anorectal malformations (ARMs) are complex congenital anomalies of the anorectal region, oftentimes also affecting the genitourinary system. Although successful surgical correction can often be achieved in the neonatal period, many children will experience functional problems in the long term. The European Reference Network for rare and complex urogenital conditions (eUROGEN) assembled a panel of experts to address these challenges and develop comprehensive guidelines for the management of ARM., Methods:  The Dutch Quality Standard for ARM served as the foundation for the development of guidelines applicable on a European level. Literature was searched in Medline, Embase, and Cochrane. The ADAPTE method was utilized to incorporate the newest available evidence. A panel of 15 experts from 7 European countries assessed currency, acceptability, and applicability of recommendations. Recommendations from the Dutch Quality Standard were adapted, adopted, or rejected and recommendations were formed considering the current evidence and/or expert consensus., Results:  Lifelong follow-up, integration, and transition of care were assessed. A total of eight new studies were identified. The panel adapted 18 recommendations, adopted 6, and developed 6 de novo. Overall, the level of evidence was considered low., Conclusion:  Successful lifelong follow-up and transition of care require a dedicated team of pediatric and adult specialist and an individually tailored patient-centered approach. This guideline summarizes the best available evidence on follow-up of ARM patients and provides guidance for the development of structured transition programs., Competing Interests: We would like to disclose that two of the authors of this adaptation report (IDB, CEJS) were also authors of the Dutch Quality Standard. However, it is important to note that neither IDB nor CEJS have any conflict of interest to declare and they did not advocate for any particular viewpoints or positions in relation to the content of the Dutch Quality Standard. No conflicting interests were declared from the other authors., (Thieme. All rights reserved.)