{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T00:46:26Z","timestamp":1791852386842,"version":"4.3.4"},"reference-count":25,"publisher":"Georg Thieme Verlag KG","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur J Pediatr Surg"],"abstract":"<jats:p>This study aimed to evaluate management strategies for anorectal malformations (ARMs) across Europe and assess the impact of institutional case volume on clinical decision-making.<\/jats:p>\n                  <jats:p>A cross-sectional online survey developed within the Trainees in European Pediatric Surgery (TEPS) and endorsed by the European Paediatric Surgeons' Association (EUPSA) Network Office was distributed among pediatric surgeons involved in ARM care. The questionnaire addressed diagnostic workup, surgical management, perioperative care, and long-term follow-up. European responses were analyzed and compared by institutional case volume.<\/jats:p>\n                  <jats:p>A total of 94 responses from 21 countries were analyzed. Substantial variability was observed across all domains of care. Ultrasound-based screening and invertogram were widely used, whereas high-pressure distal colostography was variably applied. Magnetic resonance imaging (MRI) and vaginoscopy were used more selectively. Primary neonatal repair in cases with the rectum located &lt;1\u2009cm from the perineal skin was commonly performed, and staged reconstruction was most frequently undertaken at 3 to 6 months. Non-divided stomas were more frequently used in high-volume centers (p\u2009=\u20090.002), with increasing center volume associated with higher odds of their use (odds ratio [OR] 2.98, 95% confidence interval [CI] 1.51\u20135.87, p\u2009=\u20090.002). Routine anal dilations were reported by 44.7% of respondents and were less common in high-volume centers (p\u2009=\u20090.005); increasing volume was associated with lower odds of routine dilation (OR 0.38, 95% CI 0.20\u20130.72, p\u2009=\u20090.003).<\/jats:p>\n                  <jats:p>ARM management across Europe remains highly variable. Institutional case volume is associated with practice differences, particularly in stoma configuration and postoperative dilation strategies.<\/jats:p>","DOI":"10.1055\/a-2965-8002","type":"journal-article","created":{"date-parts":[[2026,9,22]],"date-time":"2026-09-22T23:12:53Z","timestamp":1790118773000},"source":"Crossref","is-referenced-by-count":0,"title":["Practice Variability in Anorectal Malformations Management across Europe: A TEPS-EUPSA Survey with Analysis of Center Volume Effects"],"prefix":"10.1055","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4405-0822","authenticated-orcid":false,"given":"Agnieszka","family":"Wiernik","sequence":"additional","affiliation":[{"name":"Medical University of Silesia, Silesia, Poland","place":["Katowice"],"department":["Department of Pediatric Surgery and Urology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5666-8830","authenticated-orcid":false,"given":"Marta","family":"Gazzaneo","sequence":"additional","affiliation":[{"name":"KU Leuven University Hospitals Leuven Gasthuisberg Campus Gynecology and Obstetrics, Flanders, Belgium","place":["Leuven"],"department":["Department of Obstetrics and Gynaecology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-4785-6462","authenticated-orcid":false,"given":"Ophelia","family":"Aubert","sequence":"additional","affiliation":[{"name":"University of Heidelberg, University Medical Centre Mannheim, Baden-W\u00fcrttemberg, Germany","place":["Mannheim"],"department":["Department of Pediatric Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0414-2888","authenticated-orcid":false,"given":"Julio C\u00e9sar","family":"Moreno-Alfonso","sequence":"additional","affiliation":[{"name":"Navarre Hospital Complex, Navarre, Spain","place":["Pamplona"],"department":["Department of Pediatric Surgery"]},{"name":"Universidad P\u00fablica de Navarra (UPNA), Navarre, Spain","place":["Pamplona"]},{"name":"Fundaci\u00f3n Universitaria Juan N. Corpas (FUJNC), Bogot\u00e1, Colombia","place":["Bogot\u00e1"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6111-9916","authenticated-orcid":false,"given":"Jonathan","family":"Hencke","sequence":"additional","affiliation":[{"name":"Klinikum Stuttgart Olgahospital\/Frauenklinik, Germany","place":["Stuttgart"],"department":["Department of Pediatric Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6260-7830","authenticated-orcid":false,"given":"Meike S.","family":"Hofer","sequence":"additional","affiliation":[{"name":"University Hospital Schleswig-Holstein L\u00fcbeck Campus, Schleswig-Holstein, Germany","place":["L\u00fcbeck"],"department":["Department of Paediatric Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3995-7286","authenticated-orcid":false,"given":"Ivo","family":"de Blaauw","sequence":"additional","affiliation":[{"name":"Radboud University Medical Centre, Amalia Children's Hospital, The Netherlands","place":["Nijmegen"],"department":["Department of Surgery, Division of Paediatric Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rene","family":"Wijnen","sequence":"additional","affiliation":[{"name":"Erasmus MC Sophia, Rotterdam, Children's Hospital, The Netherlands","department":["Department of Pediatric Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3543-5974","authenticated-orcid":false,"given":"Judith","family":"Lindert","sequence":"additional","affiliation":[{"name":"University Medicine, Germany","place":["Rostock"],"department":["Department of Paediatric Surgery"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"ref1","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/1750-1172-2-33","article-title":"Anorectal malformations","volume":"2","author":"M A Levitt","year":"2007","journal-title":"Orphanet J Rare Dis"},{"issue":"02","key":"ref2","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1055\/s-0037-1609020","article-title":"Anorectal malformations","volume":"31","author":"R J Wood","year":"2018","journal-title":"Clin Colon Rectal Surg"},{"issue":"02","key":"ref3","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1055\/s-0044-1791250","article-title":"ERN eUROGEN Guidelines on the Management of Anorectal Malformations Part I: Diagnostics","volume":"35","author":"O Aubert","year":"2025","journal-title":"Eur J Pediatr Surg"},{"issue":"06","key":"ref4","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1016\/S0022-3468(82)80448-X","article-title":"Posterior sagittal anorectoplasty: important technical considerations and new applications","volume":"17","author":"A Pe\u00f1a","year":"1982","journal-title":"J Pediatr Surg"},{"issue":"02","key":"ref5","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1055\/s-0044-1791257","article-title":"European Reference Network eUROGEN Guidelines on the Management of Anorectal Malformations, Part II: Treatment","volume":"35","author":"O Aubert","year":"2025","journal-title":"Eur J Pediatr Surg"},{"issue":"08","key":"ref6","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1016\/j.jpedsurg.2021.04.022","article-title":"Are routine postoperative dilations necessary after primary posterior sagittal anorectoplasty? 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