Systematic review and meta-analysis shows higher wound dehiscence risk with single-stage repair for anorectal malformations in neonates and infants

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Journal of investigative surgery : the official journal of the Academy of Surgical Research Published May 11, 2026 Medically reviewed May 18, 2026 Study authors: Du Yu, Wang Yiwei, Wang Wenjing, Zhao Jingming PubMed ↗ DOI ↗ By Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

Key Takeaway

Note higher wound dehiscence risk with single-stage repair for anorectal malformations in neonates and infants.

This systematic review and meta-analysis examined surgical repair strategies for anorectal malformations in neonates and infants. The study compared single-stage repair against multistage repair across a pooled sample of 1972 patients. The primary outcome focused on wound-related complications, specifically wound dehiscence, while secondary outcomes included surgical site infection, stenosis, prolapse, redo surgery, constipation, soiling, and voluntary bowel movements.

The analysis found that single-stage repair was associated with a significantly higher risk of wound dehiscence compared to multistage repair. The odds ratio was 3.31 with a 95% CI of 1.90-5.79 and a p-value less than 0.0001. In contrast, no significant differences were observed for surgical site infection, stenosis, prolapse, redo surgery, constipation, soiling, or voluntary bowel movements between the two approaches.

The authors highlighted that moderate to high heterogeneity was noted for selected outcomes, which may affect the generalizability of the findings. Given the heterogeneity and the specific finding regarding wound dehiscence, clinicians should weigh the increased risk of wound complications when selecting a surgical approach. The review does not establish causality beyond the statistical association observed in the pooled data.

Study Details

Study typeMeta analysis

Sample sizen = 1,972

EvidenceLevel 1

PublishedDec 2026

PMID42112665

View Original Abstract ↓

BACKGROUND: Anorectal malformations (ARMs) are managed using either single-stage or multistage surgical repair. However, concerns persist regarding wound-related complications and long-term functional outcomes, which remain inconsistently reported across surgical approaches. OBJECTIVE: To compare wound-related complications and long-term functional outcomes following single-stage versus multistage repair of ARMs, with emphasis on wound perfusion, dehiscence, and vascular healing dynamics. METHODS: A systematic review and meta-analysis were conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD420251006245). PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for studies published between 2000 and 2024 comparing single-stage and staged ARM repair in neonates and infants. Outcomes included wound dehiscence, surgical site infection (SSI), stenosis, prolapse, redo surgery, constipation, soiling, and voluntary bowel movements. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Study quality was assessed using the Methodological Index for Non-Randomized Studies (MINORS). RESULTS: Nineteen studies involving 1,972 patients were included. Single-stage repair was associated with a significantly higher risk of wound dehiscence (OR 3.31; 95% CI 1.90-5.79; < 0.0001), while no significant differences were observed for SSI, stenosis, prolapse, redo surgery, constipation, soiling, or voluntary bowel movements. Moderate to high heterogeneity was noted for selected outcomes. CONCLUSIONS: Single-stage repair provides comparable infection rates and long-term functional outcomes to multistage surgery but carries an increased risk of wound dehiscence. Optimizing tissue perfusion and minimizing tension are essential to improve outcomes.