Patterns and outcome of surgical management of anorectal malformations at a tertiary care hospital in resource limited setting: a Tanzanian experience

Abstract

Background: Anorectal malformations (ARM) are common congenital abnormalities in most parts of the world and its management remains a challenge to surgeons practicing in resource-limited setting such as Tanzania. This study aimed to determine the patterns and outcome of surgical management of ARM at a Tanzanian tertiary care hospital.

Methods and Patients: This was a cross sectional study (with a follow up component) of patients with ARMs admitted to Bugando Medical Centre between May 2014 and April 2017.

Results: A total of 109 patients (M: F ratio= 1:1.4) were studied. The median age at diagnosis was 50 days. The majority of patients, 78(71.6%) were less than a year old. Most of patients, 91(83.5%) had major clinical type of ARMs. Associated congenital anomalies were recorded in 18 (16.5%) patients. The majority of patients, 64(58.7%) reported to hospital late in acute intestinal obstruction. Most of patients in this study, 107(98.2%) were initially managed by a preliminary colostomy before definitive treatment. Out of 109 patients with ARMs, only 39 (33.0%) underwent definitive operations. Of the 107 patients who had preliminary colostomy, only 28(26.2%) had their colostomies closed at the end of study period. The overall complication and mortality rates were 47.7% and 16.0% respectively. Delayed presentation (> 48 hours), associated congenital anomalies, prolonged duration of operation (> 3 hours) and surgical site infections were the main predictors of mortality (p < 0.001). The follow up of patients in this study was generally good as only 3(8.3%) patients were lost to follow up. Good results using Kelly’s scoring system were obtained in 83.3% of surviving patients.

Conclusion: Anorectal malformations are common in our setting. The major type of ARMs is commoner than the minor type. The outcome of surgery is good when the patients present early at birth. Therefore there is need for increasing community awareness and among all healthcare workers who handle neonates to effect early presentation and therefore prompt management.