Parental attitudes to neoanus dilatations post-reconstruction in anorectal malformations (PANDA) study.

Abstract

Purpose: Some surgeons train parents to undertake routine neoanus dilatations following anorectal malformation surgery. Recent studies suggest this may not significantly reduce the incidence of strictures. This study sought to understand parental experiences of and perceptions about this intervention to guide best practise and inform further studies of clinical impact.

Methods: This qualitative study, using reflexive thematic analysis was carried out in a single institution. Five parents took part in an audio-recorded focus group with 13 families subsequently taking part in audio-recorded semi-structured interviews. Concurrent analysis of verbatim transcripts guided iterations in data generation.

Results: Four major themes were identified; (1) parents understood the importance of dilatations; (2) parents experienced distress with anxiety, fear of causing harm and guilt; (3) parents perceived a traumatic reaction from infants including anticipatory stress; and (4) some parents perceived detrimental impact on inter-parental relationships with an imbalance in responsibilities for dilatations.

Conclusions: Parents who accept the importance of dilatations, are placing trust in their clinicians' guidance despite their negative experiences of the intervention and perceived relational costs between themselves and their child. As the quantitative clinical evidence for neoanus dilatation remains, at best, equivocal, we do not recommend routine dilatations post-reconstructive surgery for anorectal malformations.