Management of Ano-Rectal Malformations in a Tertiary Level Children’s Hospital of Nepal

Thapa, Bhola; Basnet, Balmukunda; Pun, Madhusudan; Thapa, Anupama

doi:10.3126/jnps.v33i3.8190

Cited by 3 publications

(3 citation statements)

References 14 publications

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“…[6] Timely diagnosis, management of associated anomalies, efficient surgical repair provide the best chance for a good functional outcome in patients. [7] We aimed to analyze the early outcomes (morbidity and mortality statistics) of a cohort of patients of ARM presenting in the neonatal period in a high-volume tertiary care teaching institute from the north-western region of India.…”

Section: Introductionmentioning

confidence: 99%

Anorectal malformations: Early outcome analysis in a tertiary care center in India

Mathew

Gupta

et al. 2021

J Neonatal Surg

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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). Colostomy prolapse was uncommon (2). The overall mortality was 87/315 (27.61%) neonates - 82/265 (30.94%) in HARM and 5/50 (10%) in LARM. Neonatal mortality was significantly high with birth weight <2500gm 55/153 (35.94%; p value= 0.0001), associated malformations 82 (67.76%, p value= 0.003); and delayed presentation 40/87 (45%), and with primary perforation 5/6 (83.33%). Conclusions: Higher mortality was associated with low birth weight, double/ triple atresia, neonatal GIT perforation, sepsis on admission, and those with oesophageal and cardiac anomalies. More than 1/3rd (38.41%) patients had associated anomalies; thus, a detailed systematic evaluation of all subtypes is paramount.

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Section: Introductionmentioning

confidence: 99%

Anorectal malformations: Early outcome analysis in a tertiary care center in India

Mathew

Gupta

et al. 2021

J Neonatal Surg

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“…The final prognosis and quality of life for children with ARMs depend, to a large extent, on the presence and severity of these associated anomalies [11]. Early diagnosis, management of associated anomalies, and efficient meticulous surgical repair provide patients the best chance for a good functional outcome [12]. Various types of colostomy formation have been in use at various pediatric surgery centers.…”

Section: Introductionmentioning

confidence: 99%

Outcome of Divided and Loop Sigmoid Colostomy for the Management of Anorectal Malformation (ARM): A Comparative Study

Hossain¹,

Rahman²,

Saifullah³

et al. 2023

Glob Acad J Med Sci

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Background: Anorectal Malformation (ARM) is one of the common congenital anomalies in the world. There are various surgical options for management of ARM. Colostomy is usually performed as a first stage in a new born with high and intermediate variety of anorectal malformations. The aim of the study was to compare the clinical outcomes between divided and loop sigmoid colostomy for the management of anorectal malformations. Material and Methods: This prospective comparative study was conducted on 130 pediatric patients at the Faculty of Pediatric Surgery, Bangladesh Shishu Hospital and Institute, who were admitted with anorectal malformations (ARM) up to 7 days of age, from March 2018 to February 2021. Informed consent was obtained after proper counselling with the guardian. They were randomly assigned to the divided sigmoid colostomy group (group 1=65 neonates) and loop sigmoid colostomy group (group 2=65 neonates). The comparative parameters between two groups were the operation time, post-operative complications such as wound infection, skin excoriation, prolapse of colostomy, retraction of colostomy and parastomal hernia. All patients were followed up for 2 months post-operatively. Results: The mean age of the patients was 2.43±1.39days in group 1 and in group 2, the mean age was 2.61±1.73 days where majority of the patients were male. The statistical difference between the two groups regarding operation time was highly significant (0.0001). After operation, 26.15% patients developed skin excoriation in group 1 where in group 2, 29.23% patients developed skin excoriation. In group 1, 6.15% patients developed wound infection but none of them developed prolapse, retraction of colostomy and parastomal hernia. On the other hand, in group 2, 1.54% patient developed wound infection, 15.38% patients developed prolapse and 6.15% patients developed retraction of colostomy and no patient experienced parastomal hernia. The statistical difference between the two groups regarding prolapse of colostomy was significant (p=0.042). Conclusion: In our study, the frequency of different stoma-related problems was greater in the loop colostomy group, although being statistically insignificant. In the divided group, there was significantly less stoma prolapse. In light of these results, divided stoma should be suggested for newborns with ARM.

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“…The earlier methods of classification of the malformations such as the Wingspread classification and the international classification did not standardize the indications and choices of intervention; however, Pena's classification includes some indications aimed at standardising the choices and types of treatment available to the patients. [7,8] The objective of this study was to determine the accuracy, sensitivity, and specificity of lateral invertogram in the diagnosis of anorectal malformations and to ascertain the role the lateral invertogram plays in the classification and definitive treatment of patients with anorectal malformations.…”

Section: Introductionmentioning

confidence: 99%

Accuracy of Lateral Invertogram in diagnosing and classifying anorectal malformations

Nwokoro¹,

Ayoade²,

Ba³

et al. 2020

Ann Health Res

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Background: The initial management of a new born baby with anorectal malformation could be made only after an accurate determination of the level of the anomaly. Objective: To determine the accuracy of lateral invertogram in diagnosing and classifying anorectal anomalies. Methods: This was a retrospective study carried out between January 2003 and December 2013. The accuracy, sensitivity, and specificity of lateral invertogram in diagnosing and classifying anorectal malformations in the cases studied were determined. Results: A total of 62 children with anorectal malformations patients were seen during the study period. The age range was 4 hours to 6 years. A total of 50 (80.6%) had lateral invertogram while only 39 films of lateral invertogram were available for analysis. A total of 22 patients had high anomalies while 12 patients had low anomalies. The accuracy of lateral invertogram in identifying anorectal anomaly was 100% and its ability to differentiate between high and low anomalies was 76.5%. The Sensitivity in identifying high anomalies was 59% while the specificity was 31.8%. The sensitivity in identifying low lying lesions was 66.5% while the specificity was 50%. Conclusion: The accuracy, sensitivity, and specificity of lateral invertogramin diagnosing and classifying anorectal malformations were found to be satisfactory in the present study.

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Management of Ano-Rectal Malformations in a Tertiary Level Children’s Hospital of Nepal

Cited by 3 publications

References 14 publications

Anorectal malformations: Early outcome analysis in a tertiary care center in India

Anorectal malformations: Early outcome analysis in a tertiary care center in India

Outcome of Divided and Loop Sigmoid Colostomy for the Management of Anorectal Malformation (ARM): A Comparative Study

Accuracy of Lateral Invertogram in diagnosing and classifying anorectal malformations

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