Analysis of 200 cases with Pediatric Anorectal Malformations (original) (raw)
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Treatment of Children with Anorectal Malformations—10-Year Review
OALib, 2015
Introduction: Anorectal malformations include a wide spectrum of congenital defects of the anus, anal canal and rectum, which are often combined with urogenital tract defects. They are often associated with congenital anomalies of other organ systems such as genitourinary, cardiovascular, digestive, skeletal, etc. Objectives: This study aimed to review the patients with anorectal malformations, diagnosis, different types of associated anomalies and their frequency, modalities of treatment, results of treatment and complications. Materials and Methods: Since 2010, we have performed a combined retrospective and prospective analysis of a total of 76 patients with anorectal malformations which were diagnosed and treated at our clinic between 2005 and 2014. Results: Of 76 patients with anorectal malformations, 48 were male (63.16%) and 28 female (36.84%).
Outcome and Complications of Anorectal Malformations
IOSR Journals, 2019
Anorectal Malformation [ARM] is a relatively common, complex anomaly to treat, improvement in management has improved life style of ARM child. We have studied every case of ARM admitted in GMKMCH between January 2012 and December 2016 (total 81 ). Children admitted are first stabilized and examined clinically after 24 hours subjected to invertogram and treated according to type of anomaly. Male babies with low anomaly are treated with anoplasty. Female babies are subjected to posterior trans position of anus at 3 months of age. High and intermediate anomalies are treated with 3 stage procedures. It was found that ARM is common in low socio economic group with equal gender incidence. Half of the cases are associated with other anomalies which is most common cause of death. Laparoscopic Assisted Anorectoplasty [LAARP] is better for high ARM and Posterior Sagital Anorectoplasty [PSARP] for intermediate ARM. Functional outcome of low ARM is good compared to high and intermediate ARM
Anorectal malformations in children
Journal of Indian Association of Pediatric Surgeons, 2006
Background/Purpose: Anorectal malformations are one of the most common congenital defects. This study was undertaken to study the hospital incidence of anorectal malformations (ARM), frequency of various types of defects, their sex distribution and the spectrum of anomalies associated with ARM. The effect of presence of an associated defect on mortality and morbidity was also studied. Materials and Methods: One hundred consecutive children attending the pediatric surgery department were included in this study. A detailed history was taken, and examination was performed for the primary as well as the associated defects. Appropriate investigations like invertogram, cologram were done wherever indicated. Management was as per the standard protocol. The data was recorded and analyzed. Results: Out of the 100 patients, 51 were males and 49 females. One out of every 6.62 admission was for ARM. Twenty percent of the female babies had high, 76% intermediate and 4% had low anomalies, whereas 80.39% males had high, 3.92% intermediate and 15.6% showed low malformations. Ten percent of the patients had pouch colon. Associated anomalies were seen in 33 patients-20 males and 13 females; 19 in high, 10 in intermediate, 1 in low group and 3 children with cloacal malformations. Associated defects seen were urogenital (17%), cardiovascular (7%), gastrointestinal (9%), genital (5%) and limb defects (7%). There were 8 deaths, and complications were seen in 13 patients. Ten patients had two or more defects associated with ARM. Conclusions: Anorectal malformations occurred equally in males and females. Females had intermediate defects more frequently, rectovestibular fistula being the commonest. Males were more likely to have high lesions; anorectal agenesis without fistula was the commonest defect. The most common associated defects seen were vesicoureteric reflux and esophageal atresia. Complications were seen more commonly in males with high lesions. There was a significant association between presence of an associated defect and mortality and morbidity.
2017
Background: Anorectal malformations (ARM) occur in approximately 1 in 5000 live births and affects males and females almost equally. Operative correction of pediatric ARM is of potential clinical interest; however, long-term outcome of patients in respect to probable complications requires precise follow up and surveillance. The aim of the present study was to assess the outcomes of children undergoing surgical correction of ARMs. Materials & Methods: In a prospective follow-up study, we wanted to assess occurrences of incontinence, constipation, soiling, abdominal distension, diarrhea, stenosis, dilated sphincter and failure to thrive (FTT) in ARM patients. In addition, management of these conditions has been discussed. Reoperations have also been reviewed. The primary outcome of the study was determination of occurrence of incontinence at follow-up visits. Secondary outcomes were occurrence of constipation, anal stenosis, soiling, abdominal distension, dilated sphincter, diarrhea ...
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...
Journal of Medical Sciences, 2021
Tariq Waheed , Sajjad Ali , Muhammad Uzair ,Inayat Ur Rehman Objective: To share our experience with outcome of primary procedure for anorectal malformation (ARM) in children. METHODOLOGY: Retrospective study included 40 patients from both sexes operated between January 2018 and January 2019 for high and intermediate ARM in the department of paediatric surgery Khyber teaching hospital Peshawar. Patients with common cloaca and associated life threatening anomalies were excluded. Demographic and clinical data was tabulated and analyzed. Cost of the procedure was recorded in Pakistani Rupees and hospital stay in days. Continence was evaluated by Kelly’s score and parents’ satisfaction graded by Likert scale. RESULTS: Male to female ratio was 1.6:1. Mean hospital stay was 5.91±1.01 days and mean cost of 22950 ± 3234 PKR. Wound dehiscence was recorded in 3 (7.5%), 2 (5.0%) patients developed surgical site infection and 11 (35.48%) patients had perianal excoriation. Adhesive obstruction a...
2016
Introduction : the aim of our study was to perform a longitudinal follow-up in patients with anorectal malformations(ARMs) in order to determine the anorectal function problems and help to solve them. Material and Methods : This study included 262 patients with ARM who were operated between 2006 until 2013.Children whose definitive reconstruction was performed at another hospital and underwent reoperation in our center were excluded. Patients who expired or did not come for follow-up were not included in the study either. Bowel function was prospectively assessed by using a questionnaire answered by the children’s parents. supplementary bowel management with enemas, laxatives and the use of diapers were documented as well. Results : Interviews were completed in 242 children, ages ranging from 3 to 10 years. More than thirty seven (37.7%) patients had constipation.32.5% Grade 1 (controllable by altering in diet), 54.3% Grade 2 (requiring laxatives) and 13.2% Grade 3(opposed to stool ...
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.
Prevalence and survival of patients with anorectal malformations: A population-based study
Journal of Pediatric Surgery, 2019
Background: Anorectal malformations (ARMs) are the most frequent congenital intestinal anomalies. The aim of this study was to describe the epidemiology of anorectal defects between 1981 and 2014 and to evaluate patients' survival. Methods: A population-based study using data collected by an Italian, regional registry of birth defects and by the local Pediatric Surgery Units. Results: A total of 428 individuals with ARM were identified, with an overall prevalence of 3.09 per 10,000 births. Characteristics associated with decreased survival were low birth weight (b 2500 g) (HR 6.4; 95% CI, 2.3-17.9), the presence of two or more additional major defects (HR 7.9; 95% CI, 2.2-27.8), and birth before year 2000 (HR 4.7; 95% CI, 1.8-11.8). The 10-year survival probability was 100% for individuals with isolated ARM, regardless of their birth weight. Survival of patients with non-isolated ARM varied according to their year of birth and birth weight: 73.3% (≥2500 g) and 23.8% (b2500 g) in children born before 2000; 97.9% (≥2500 g) and 68.8% (b2500 g) in children born after year 2000. Conclusions: This study found a significant improvement in the survival of individuals with anorectal malformations over the past decades and identified the strongest predictors of mortality. Level of evidence (prognosis study): Level II.