Comparison in the incidence of anorectal malformations between a first- and third-world referral center

Abstract

Purpose Aim of study was to evaluate the differences in incidence and presentation of anorectal malformations (ARMs) between selected Pediatric Surgery Divisions in the Republic of South Africa (ZAR) and Italy. Methods A retrospective cohort study involved analysis of clinical records of patients with ARM born between 2005 and 2012. Type of ARM, maternal age, birth weight, gestational age, presence of associated anomalies and delayed diagnosis were analyzed. Results 335 patients were included in this study. Of note, statistically significant differences between the African and European patient groups were observed in a male predominance in the ZAR patient population. In addition, female recto-perineal fistulas were diagnosed in significantly more Italian patients than in ZAR. Furthermore, a more advanced maternal age and a lower gestational age was noted in the European cohort with a minimal delay in initial diagnosis as opposed to the African counterpart. Both centers reported recto-perineal fistula as the most common malformation in male patients. Conclusion With the exception of perineal fistulas in females, the incidence of specific subtypes of ARMs was similar in the two groups. This may be of importance when extrapolating European study conclusion to the South African setting.

Management of Anorectal Malformation: Experience from Ethiopia

“…Associated congenital malformation accounted for 44% (44/99) of patients. The large number of associated congenital malformation seen in this study is similar with the studies conducted in other studies (2,6,7,13). Genitourinary malformations are the dominant associated lesions detected in this study which is 31% (31/99) and it is in line with the studies done somewhere else (2, 11-13).…”

“…This finding is similar to the study done in Italy where 54% of their patients are females and to the proportion noticed from our institute 36 years back, 53%:47% respectively (7,8). However, study done in South Africa indicated that the ratio of male to female patients is grossly equal (4,6,9). There was a delay in presentation in 94 % of the cases.…”

“…These malformations are present in 45-65% of neonates with ARMs (6). These congenital malformations include urogenital, cardiac, vertebral, spinal and gastrointestinal abnormalities in the majority of the cases (6).The management of ARM ranges from classical Postero-sagittal anorectoplasty (PSARP) to minimal invasive procedures such as minimal anoplasty. The aim of the surgical management is to reconstruct the rectum/anus, genital tract and the urinary tract.…”

Correlation of Maternal Age with Prevalence of Chromosomal Anomalies in Patients of Anorectal Malformation

“…Average maternal age in ZAR group and Italian group was, respectively, 28 and 34 years (p = 0.0001). [10] Ciongradi et al (2016) did retrospective analysis of 146 patients with ARM in which mothers age ranged from 16 to 42 years old, with a mean age of 21.3 ± 2.3 years old. [11] In the present study age of mothers ranged from 19 to 36 years with a mean age of 25.04±4.10 years.…”

Anorectal malformations and the impact of HIV on surgical outcome

“…This traditional approach is especially applicable in LMICs, where patients often present late with established obstruction of the gastrointestinal tract, systemic sepsis and dehydration. [4][5][6][7] Some lesions are amenable to a primary PSARP without formation of a colostomy if the anatomical defect is favourable, the child is clinically stable and has no associated life-threatening congenital anomalies, and there is no gross abdominal distension. [8] In the paediatric population, intra-abdominal surgery is associated with a 20% surgical site infection rate and an 11% anastomotic leak rate.…”