Primary Procedure for Anorectal Malformations in Children; A Single Center Experience

Abstract

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 and mucosal prolapse were seen in 1 (2.5%) patient each while anal stenosis in 2(5.0%) Patients. After 6 months 28 (70%) patients had formed stools while 12 (30%) had loose stools. Stool frequency was 0-1 time/day in majority i.e. 20 (50 %) patients. Continence was fair in 24 (60%) patients. Parents of 20 (50%) patients were very satisfied, 17(42.5%) satisfied only. Continence for age and sex revealed insignificant P values of 0.213 and 0.07 respectively.
 CONCLUSION: Primary procedure for anorectal malformations may be a good alternative to traditional three stage procedure in selected patients with intermediate and high variety of ARM.
 KEY WORDS: Anorectal malformation (MeSH); Abdominoperineal pull through (Non-MeSH); Kelly’s score (Non-MeSH).