PRIMARY PROCEDURE FOR ANORECTAL MALFORMATIONS IN CHILDREN; A SINGLE CENTER EXPERIENCE: A single center experience (original) (raw)
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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.
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: 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: 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
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...
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 ...
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.
Current management of anorectal malformation in Egypt
Annals of Pediatric Surgery
Background/aim Anorectal malformation (ARM) represents a wide spectrum of anomalies. Its management includes various strategies. This survey aims at detecting the current preferences of Egyptian pediatric surgeons regarding the management of ARM.
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.
2020
Introduction: Anorectal malformation [ARM] can be treated either by staged procedures or by a single stage procedure. In the present study we have performed single stage surgery of ARM in male neonates. Materials and Methods: Retrospective review of cases of ARM operated over 4 years at Indira Gandhi Institute of Medical Sciences, Patna, and Bihar from January 2015 to December 2018 were undertaken. In this study we have compared the results of single stage repair of Anorectal malformation with that of staged procedures performed earlier. Fifty four patients of Anorectal malformation were operated by single stage procedure (category 1) this was compared with staged procedures (category 2). Forty three patients underwent primary PSARP (posterior sagittal anorectoplasty) and the remaining 11 primary APP (abdomino-perineal pull through) procedure. The result of these single stage procedures were compared with that of staged procedures (category 2) in which a total of 39 cases were opera...