Pitfalls and technical errors in the first approach to neonates with anorectal malformations in a non-specialist context: can we do any better? A review from three Eastern African Centres (original) (raw)
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Management of anorectal malformation: Changing trend over two decades in Zaria, Nigeria
African Journal of Paediatric Surgery, 2011
Background: Anorectal malformation is a common congenital defect and its management has evolved over the years. This is a review of the trend in the management of this condition in a major paediatric surgical centre in Nigeria over two decades. Materials and Methods: A retrospective analysis of 295 patients with anorectal malformations managed from January 1988 to December 2007 was carried out. Results: There were 188 boys and 107 girls aged 1 day-9 years (median 8 years) at presentation. There were 73 (54.5%) and 106 (65.8%) emergency operations in groups A and B, respectively. There were 61 (45.5%) and 55 (34.2%) elective operations in groups A and B, respectively. Regarding treatment, in group A, patients requiring colostomy had transverse loop colostomy, while in group B, sigmoid (usually divided) colostomy was preferred. The definitive surgery done during the two periods were: group A: cutback anoplasty 29 (47.5%), anal transplant 5 (8.2%), sacroabdominoperineal pullthrough (Stephen's operation) 6 (9.5%) and others 21 (34.4%). In group B, posterior sagittal anorectoplasty (PSARP) 46 (83.7%), anal transplant 1 (1.8%), posterior sagittal anorectovaginourethroplasty (PSARVUP) 2 (3.6%) and anal dilatation 6 (10.9%) were done. Early colostomy-related complication rates were similar in the two groups (P > 0.05). The overall late complication rate was 65.5% in group A and 16.4% in group B (P < 0.05). The mortality was 25 (18.6%) in group A compared to 17 (10.6%) in group B (P < 0.05). Conclusion: There have been significant changes in the management of anorectal malformations in this centre in the last two decades, resulting in improved outcomes.
Pediatric Surgery International, 2015
Purpose Aim of study was to evaluate the differences in incidence and presentation of anorectal malformations (ARMs) between selected Pediatric Surgery Divisions in the Republic of South Africa (ZAR) and Italy. Methods A retrospective cohort study involved analysis of clinical records of patients with ARM born between 2005 and 2012. Type of ARM, maternal age, birth weight, gestational age, presence of associated anomalies and delayed diagnosis were analyzed. Results 335 patients were included in this study. Of note, statistically significant differences between the African and European patient groups were observed in a male predominance in the ZAR patient population. In addition, female recto-perineal fistulas were diagnosed in significantly more Italian patients than in ZAR. Furthermore, a more advanced maternal age and a lower gestational age was noted in the European cohort with a minimal delay in initial diagnosis as opposed to the African counterpart. Both centers reported recto-perineal fistula as the most common malformation in male patients. Conclusion With the exception of perineal fistulas in females, the incidence of specific subtypes of ARMs was similar in the two groups. This may be of importance when extrapolating European study conclusion to the South African setting.
Management of Anorectal Malformation: Experience from Ethiopia
Annals of African Surgery
Background: Anorectal malformations are among the most common congenital malformation seen in children. There is paucity of data regarding the incidence and treatment outcome of this disease from Ethiopia. Methods: This is a retrospective review of patients treated for ARM at the TASH from March 2010-February 2014. Relevant statistical analysis was done and the results presented in tables and graphs. Results: Six patients (6%) presented at early neonatal age (before the age of 4 days) and 14 (14%) presented between 4 days and one month. A total of 57 associated congenital malformations were diagnosed in 44/99(44%) patients. The two most common type of ARM diagnosed among the female patients were rectovestibular fistula which occurred in 39/56 (70%) and
Factors affecting the outcome of neonates with anorectal malformation in a developing country
2021
Background: The survival and outcome of neonates with anorectal malformations (ARM) have much improved in the developed countries due to optimal perioperative and postoperative care but in developing countries, sepsis, low birth weight, delayed presentation, and lack of intensive care for neonates are still important in affecting the outcome. This study was carried out to evaluate factors of poor outcome (mortality) in neonates with ARM. Method: This is a prospective analytical study. A total of 44 consecutive neonates with Anorectal malformations (ARM) presenting to the Department of Pediatric Surgery, The Children’s Hospital, Pakistan Institute of Medical Sciences, Islamabad, were included. Variables studied included age at presentation, gender, birth weight, type of malformation, sepsis at presentation, type of surgery performed, postoperative complications, and their relationship to the outcome. The statistical analysis was performed using SPSS version 21. Results: A total of 44...
Anorectal malformations: Early outcome analysis in a tertiary care center in India
Journal of Neonatal Surgery, 2021
Background: Delayed diagnosis, referral, and presence of associated anomalies may influence the outcome of Anorectal malformations (ARM). The aim of this study was to analyze the early outcomes (1 month postoperatively) of ARM presenting in the neonatal period. Methods: A prospective study was carried out in our tertiary care teaching institute from December 2018 to March 2020. All neonates admitted in the NICU with ARM were studied. Results: There were 315 neonates; out of these, 236 (74.92%) were male and 79 (25.07%) were female. High ARM (HARM) was present in 265 (84.13%) and low ARM (LARM) in 50 (15.87%). Associated congenital anomalies were noted in 121 (38.41%). Major associated anomalies consisted of gastrointestinal (GIT) (41.32%), oesophageal (31.4%), and genitourinary (GU) (19.83%). Out of 306 procedures for ARM, 196 (64.05%) neonates underwent left transverse colostomy (LTC). The most frequent postoperative complications were thrombocytopenia (115) followed by sepsis (98)...
Management of anorectal malformation in neonates
Indian journal of pediatrics
Anorectal malformations are one of the commonest anomalies in the new born. Major advances have been made in the last decade in operative techniques to reconstruct this abnormality. The final outcome in these babies is dependent on careful planning and operative intervention in the neonatal period. The purpose of this paper is to discuss the varied presentations of this anomaly, initial assessment and operative management with reference to our own experience.
Pediatric surgery international, 2015
Various management strategies for anorectal malformations (ARM) have been proposed. The aim of this study was to assess the current management in centers of excellence in Europe. An online survey on the pre- and post-operative concepts, surgical techniques, and the management of complications was sent to the representative experts of 28 selected European centers of pediatric surgery with special expertise in the treatment of ARM. The survey was completed by 25 experts from 14 countries. To assess the level of the rectal pouch in newborns 60 % of participants perform a prone cross-table X-ray and 52 % ultrasound. If an ostomy is required, 84 % create divided Peña stomas. Primary repair in the newborn period is performed in females with rectoperineal (92 %), rectovestibular (60 %), and no fistula (32 %), and in males with rectoperineal (92 %), rectourinary (17 %) and no fistula (38 %). For 68 % of surgeons, the PSARP is the preferred surgical approach for "low" malformations...
International Journal of Surgery Science
Background: Anorectal malformation is a common cause of intestinal obstruction in children. Anorectal malformation is a common congenital defect and its management has evolved over the years. Most of the patients presented as newborns to the emergency department. This is because anorectal malformation commonly presents with intestinal obstruction which is an emergency, patients frequently presented late with marked abdominal distension. Aims and Objectives: This is a retrospective and prospective review of medical records, operation registers and operation notes of patients managed for anorectal malformation at SMS Medical college and hospital in department of pediatrics surgery from June 2021 to June 2023. The main aim of this study is ''a review of the trend in the management of anorectal malformation in a major pediatric surgical center in India''. Materials and Methods: A retrospective and prospective analysis of 590 patients with anorectal malformations managed from June 2021 to June 2023 was carried out. Demographic data, type of anomaly, mode of presentation, evaluation, treatment and outcome of treatment were obtained. Total 590 patients data recorded. Data obtained were analysed using SPSS version 11.0. The χ 2 test was used to test for level of statistical significance. Level of statistical significance was set at 0.05. Results: From this study we found that-There were a total 590 patients (376 boys and 214 girls). The median age at first surgery was 8 days (range 1 day-9 years). There were 358 emergency operations in and 232 elective operations were done. The main investigations for evaluation were a lateral cross table X-ray, abdominal ultrasonography, sacral X-ray, echocardiography and a distal cologram. Total 330 patients requiring colostomy had a transverse loop colostomy. 14 patients with recto-vestibular fistula were given a colostomy before the definitive surgery, while 28 patients with recto-vestibular fistula were managed without a colostomy. The definitive surgery done in 70 [30.14%] were cutback anoplasty, sacro-abdominoperineal pull through 12 [5.17%], posterior sagittal ano-rectoplasty [PSARP] 104 [44.8%], anal dilatation 34 (14.6%), cruciate incision 8 (3.4%) and posterior sagittal ano-recto-vagino-urethroplasty (PSARVUP) 4 (1.72%) were done. Early complications were colostomy related. The early complication rate was 14% (46 of 330). Most common complications are bowel evisceration 30.4%, surgical site infection 26%, stoma necrosis 13%, stoma stenosis 13%and stoma retraction 8.69% were found. Late complications following definitive treatment were: faecal incontinence 5 (4.3%), anal stenosis 70 (60.34%), rectal retraction 18 (15.5%), mucosal prolapse 20 (17.24%) and faecal soilage 3 (2.58%). Cause of death were 18 [3%] in which main causes are-anaesthetic deaths 2 (11.1%), overwhelming sepsis 4 (22.2%), dys-electrolytaemia 4 (22.2%) and nonspecific 8 (44.4%). Conclusion: There have been significant changes in the management of anorectal malformations in this center, resulting in improved outcomes. This has been due to better understanding of the pathological condition and refinements in the surgical treatment.