Single Stage Management of Anorectal Malformation in Male Neonates: Experience of a Tertiary Care Centre (original) (raw)
Related papers
Journal of Neonatal Surgery
Background: The conventional surgical management for a male neonate with intermediate Anorectal Malformation (ARM) involves three stages – the creation of a diversion stoma in the neonatal period, a definitive pull-through procedure/ Posterior Sagittal Anorectoplasty (PSARP) followed by stoma closure. With this background, we present our experience with Single-stage primary definitive repair in selected male neonates with ARM. Methods: Medical records of male ARM cases managed from 2016 to 2018 were reviewed. Male neonates who underwent primary PSARP were analysed retrospectively. Results: A total of 35 records were found, out of which 12 male neonates underwent primary PSARP. The median gestational age and birth weight were 36.7 weeks and 2.75 kg respectively. Fistula with urinary tract was documented in all. The mean operative time was 65 minutes +/- 15 minutes. Two neonates had minor superficial surgical site infection at neo-anus. Anal dilatations were started after 2 ...
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
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...
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)...
Risk factors in the primary management of anorectal malformations in Northern India
Pediatric Surgery International, 2004
The purpose of this study was to determine the major factors influencing the survival of babies with anorectal malformation (ARM) during the primary management in the neonatal period in a tertiary referral center. The outcome of 125 neonates with ARM, treated in a single hospital during a 2-year period, was analyzed retrospectively with particular reference to birth weight, time of arrival, and the type of ARM, including pouch colon and major associated anomalies, to see whether any of them had a significant effect on initial survival. High ARM (HARM) was present in 75, low ARM (LARM) in 36, and pouch colon in 14 babies. There were a total of 28 deaths (22%). In babies with isolated HARM weighing >2.5 kg and brought to the hospital within the first 48 h of life, the survival was 100%, which dropped to 80% when brought later than 48 h. Of the babies with birth weight <2.5 kg and isolated HARM but who were brought to the hospital within the first 48 h of life, 80% survived, whereas of those reaching the hospital after 48 h, only 55% survived. Two babies with pouch colon and two of the four babies with LARM and associated anomalies died. In the HARM group, of the 31 babies with major associated anomalies, only 37% with birth weight <2.5 kg and 58% with birth weight >2.5 kg survived. Low birth weight, major associated anomalies, and delay in referral were the three important factors that influenced the outcomes of babies with ARM during the neonatal period.
Pediatric Surgery International, 2005
To compare the results of the staged procedure (Group A) with the primary single stage posterior sagittal anorectoplasty (PSARP) procedure (Group B) for high and intermediate anorectal anomalies. Four hundred ninety cases of primary single stage procedure done over a period of seven years (1996-2003) were compared with 458 out of 763 cases of staged procedure (Historical control) that underwent all three stages done from 1989 to 1996. Two hundred cases that had been in regular follow up in Group A and 254 cases in Group B who had attained three years of age were evaluated for continence by Kelly's method. The approximate cost of treatment was also calculated. Continence was good in 90 cases (45%), fair in 66 cases (33%) and poor in 44 cases (22%) in Group A while it was good in 204 cases (80%), fair in 38 cases (15%) and poor in 12 cases (5%) in Group B. In Group A, the mortality was high as only 40% cases completed all the three stages of operation. The mortality was 4.5% in Group B. Primary PSARP is recommended as the better treatment option for intermediate and high-anorectal anomalies with superior results in terms of morbidity, mortality, continence and cost.
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.
Primary Repair of High and Intermediate Anorectal Malformations in the Neonates
2006
Background/Purpose: The standard treatment of high and intermediate anorectal malformation (ARM) is the staged approach. A growing interest in one- stage correction of ARM was noted recently. The aim of this study was to examine the feasibility, safety, and short-term outcome of primary repair of high and intermediate ARM in neonates. Materials and Methods: This prospective study included 38 full-term infants (22 females and 16 males) with either high (n=9) or intermediate (n= 29 ) ARM treated during a 6- year period. All patients underwent posterior sagittal anorectoplasty (PSARP) without colostomy. The exclusion criteria included: prematurity, associated major congenital anomalies, bad general condition, persistent cloaca in females and unfavorable circumstances. Preoperative imaging using ultrasonography and magnetic resonance imaging (MRI) was performed to assess the severity of ARM and any associated anomalies. All patients were evaluated as regard to operative details, postope...
Pattern of anorectal malformation in a tertiary care hospital of Bihar
International Surgery Journal
Background: Anorectal malformation (ARM) is common cause of neonatal intestinal obstruction and is one of the most common neonatal surgical emergency encountered by paediatric surgeons. There is no published study about the prevalence of ARM cases within the referral zone of the hospital. This study was done to demonstrate the burden of Anorectal malformation and their surgical intervention as seen in Indira Gandhi Institute of medical science, Patna, Bihar.Methods: Data were retrospectively collected over a period of four years between January 2015 and December 2018. The data collected were demographic status of the patient, diagnosis, associated anomaly, duration of hospital stay and their surgical intervention.Results: There were 395 cases of anorectal malformation out of 93203 OPD patients (0.42%). Male to female ratio of 3.01:1. ARM also represented 25.3% of neonatal emergency surgical procedures. The majority of the patient had presented in the neonatal period (51.6%) with ...
Single-Stage Surgical Correction of Anorectal Malformation Associated
2016
Introduction: The treatment of children affected by ano-rectal malformations (ARM) is char-acterized by some unsolved problems. The three-stage surgical correction has been known to be most effective in preventing complications, but recently new approaches have been proposed. We describe our experience with the newer approaches. Methods: Twenty three male newborns, affected by ARM and recto-urinary fistula, were