{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T13:16:09Z","timestamp":1791897369970,"version":"4.3.4"},"reference-count":13,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T00:00:00Z","timestamp":1750291200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T00:00:00Z","timestamp":1750291200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Unidade Local de Sa\u00fade de Santo Ant\u00f3nio"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Surg Int"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Post-operative management for anorectal malformations (ARM) following surgical repair traditionally includes routine anal dilations (AD) to prevent anal strictures. Recent evidence questions its necessity and highlights psychological distress in patients and parents. We aimed to evaluate dilations\u2019 psychosocial impact on both children and caregivers.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Telephone questionnaire was performed to parents of ARM patients who underwent repair between 2009-2023, assessing their perceptions on AD and its\u2019 child impact. Patient demographics, ARM classification, AD timing, and post-operative complications were collected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Thirty-two caregivers participated. Median age at surgery was 5 months; at survey, 10.5 years. ARM with perineal fistula was the most common subtype. AD were performed preoperatively in 21.9%. Post-op, 15,6% did weekly calibrations, 62,5% daily AD. One-quarter of dilations\/calibrations were performed by a surgeon in parents\u2019 presence, of whom 62.5% reported emotional distress, 75% perception of child discomfort. Home-based AD parents reported difficulty in 54.2%, with two-thirds needing assistance, describing it as distressing for both themselves and their children. Overall, 28.1% perceived a negative psychological impact.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our findings highlight the significant psychological burden associated with AD. Given increasing evidence of its lack of benefit and psychological impact, our results support a careful re-evaluation of AD routine use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00383-025-06070-2","type":"journal-article","created":{"date-parts":[[2025,6,19]],"date-time":"2025-06-19T08:56:28Z","timestamp":1750323388000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["More harm than good? Parental perspectives on dilatations in anorectal malformations"],"prefix":"10.1007","volume":"41","author":[{"given":"Ana Isabel","family":"Barros","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M\u00e1rio Rui","family":"Correia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F\u00e1tima","family":"Carvalho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Berta","family":"Bonet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catarina","family":"Carvalho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,6,19]]},"reference":[{"issue":"5","key":"6070_CR1","doi-asserted-by":"publisher","first-page":"379","DOI":"10.3390\/bs14050379","volume":"14","author":"LA Wehrli","year":"2024","unstructured":"Wehrli LA et al (2024) \u201cTake it one dilation at a time\u201d: caregiver perspectives of postoperative anal dilations in pediatric patients with colorectal conditions. Behav Sci (Basel) 14(5):379","journal-title":"Behav Sci (Basel)"},{"issue":"6","key":"6070_CR2","doi-asserted-by":"publisher","first-page":"500","DOI":"10.1055\/s-0035-1570755","volume":"26","author":"G Brisighelli","year":"2016","unstructured":"Brisighelli G et al (2016) The practice of anal dilations following anorectal reconstruction in patients with anorectal malformations: an international survey. Eur J Pediatr Surg 26(6):500\u2013507","journal-title":"Eur J Pediatr Surg"},{"issue":"3","key":"6070_CR3","doi-asserted-by":"publisher","first-page":"243","DOI":"10.1055\/s-0038-1632392","volume":"29","author":"D Mullassery","year":"2019","unstructured":"Mullassery D et al (2019) Role of routine dilatations after anorectal reconstruction-comparison of two tertiary centers. Eur J Pediatr Surg 29(3):243\u2013246","journal-title":"Eur J Pediatr Surg"},{"issue":"8","key":"6070_CR4","doi-asserted-by":"publisher","first-page":"1449","DOI":"10.1016\/j.jpedsurg.2021.04.022","volume":"56","author":"H Ahmad","year":"2021","unstructured":"Ahmad H et al (2021) Are routine postoperative dilations necessary after primary posterior sagittal anorectoplasty? A randomized controlled trial. J Pediatr Surg 56(8):1449\u20131453","journal-title":"J Pediatr Surg"},{"issue":"1","key":"6070_CR5","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1016\/j.jpedsurg.2011.10.048","volume":"47","author":"SJ Temple","year":"2012","unstructured":"Temple SJ, Shawyer A, Langer JC (2012) Is daily dilatation by parents necessary after surgery for Hirschsprung disease and anorectal malformations? J Pediatr Surg 47(1):209\u2013212","journal-title":"J Pediatr Surg"},{"issue":"6","key":"6070_CR6","doi-asserted-by":"publisher","first-page":"543","DOI":"10.1007\/s00383-015-3700-5","volume":"31","author":"A Morandi","year":"2015","unstructured":"Morandi A et al (2015) Survey on the management of anorectal malformations (ARM) in European pediatric surgical centers of excellence. Pediatr Surg Int 31(6):543\u2013550","journal-title":"Pediatr Surg Int"},{"issue":"11","key":"6070_CR7","doi-asserted-by":"publisher","first-page":"1095","DOI":"10.1007\/s00383-012-3169-4","volume":"28","author":"E Jenetzky","year":"2012","unstructured":"Jenetzky E et al (2012) Practice of dilatation after surgical correction in anorectal malformations. 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Semin Pediatr Surg 19(2):160\u2013167","journal-title":"Semin Pediatr Surg"},{"issue":"1","key":"6070_CR10","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1017\/S0954579406060135","volume":"18","author":"TH Diseth","year":"2006","unstructured":"Diseth TH (2006) Dissociation following traumatic medical treatment procedures in childhood: a longitudinal follow-up. Dev Psychopathol 18(1):233\u2013251","journal-title":"Dev Psychopathol"},{"issue":"1","key":"6070_CR11","doi-asserted-by":"publisher","first-page":"15","DOI":"10.4103\/0971-9261.69135","volume":"15","author":"GK Pruthi","year":"2010","unstructured":"Pruthi GK, Mohta A (2010) Psychosocial burden and quality of life in parents of children with anorectal malformation. 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