Anorectal malformations A complex disease in need of a multidisciplinary approach

In children born with an anorectal malformation (ARM), the anus is wrongly placed outside the external sphincter complex. Different types of ARM exist, and in patients with ARM different associated anomalies can occur. Additional anomalies are described, among others, as part of the VACTERL-association (Vertebral, Anorectal, Cardiac, Trachea-Esophageal, Renal and Limb anomalies), but also anomalies of the spinal cord or gynecological anomalies are described. In the first part of this thesis, the types of ARM are introduced and it is described what additional anomalies might be associated with any type of ARM. In addition, the value of screening for the different types of anomalies is demonstrated throughout this part. The studies performed in Chapter 1-5 were retrospective cohort studies. In the second part, a complex type of ARM; rectal atresia (RA) is discussed in Chapter 6-8. Finally, Chapter 9-10 form the third part of this thesis describing problems later in life in patients with ARM in primary school or after transitioning to adulthood.