Management Of Anorectal Malformation In Children: A 10 Year Experience In Sokoto, Nigeria

Abstract

Background: Significant progress has been made in the past two decades in the surgical correction of the various types of anorectal malformations in early childhood.
Objective: To report our ten year experience in the management of anorectal anomalies in children in a retrospectively evaluated series in a teaching hospital in Nigeria.
Patients and Methods: A total of 65 children were studied: 38 (56.5%) were males while 24 (41.5%) were females. Age at presentation ranged from 12 hours to seven years. Within 3 days of birth 28 (73.7%) males while 8 (29.6%) females presented. The types of anomalies were; 35 (53.8%) low, 11 (16.9%) intermediate, and 19 (29.2%) high. Other associated anomalies occurred in 9 (13.8%) patients. Initial treatment included nasogastric tube suction, intravenous fluids and in 25 (38.5%) defunctioning colostomy. Definitive repair was performed on 53 (82.8%) patients. The operations performed included posterior saggital anorectoplasty (PSARP) in 28 (52.8%) patients, cutback anoplasty in 6 (11.3%), perineal transplant in 3 (5.5%) and abdominoperineal pull-through with PSARP in 5 (9.4%) patients. Postoperative anal dilatation was commenced in the ward in all patients.
Outcome of Treatment: Postoperative complications that required reoperation included anal stricture, in 3 (5.3%) excessive mucosa in 5 (9.4%) faecal incontinence in 3 (5.3%) and rectal reservoir syndrome which occurred in 3 (5.3%) patients. Bowel control was assessed after three years in 48 patients and classified as good control in 39 (81.3%) and fair in 9 (18.8%) patients. No patient had poor bowel control. The overall mortality was 12 (18.8%).
Conclusion: The impact of modern techniques may be seen in our low mortality and high success rate. Our results can improve further with early presentation of patients, accurate definition of anomalies, careful choice of available techniques and reduced utilization of neonatal colostomy.


Keywords: Anorectal malformation, Anorectoplasty, Bowel function.

Sahel Medical Journal Vol. 10 (4) 2007: pp. 128-131