One-stage correction of intermediate imperforate anus in males: preliminary results

Abstract

Background: This prospective study was designed to assess the safety, cost effectiveness, and advantages of performing posterior sagittal anorectoplasty without colostomy on males with intermediate imperforate anus. Method: Five consecutive males with intermediate imperforate anus were entered into the study. Chest and abdominal x-rays, skeletal surveys, renal ultrasound scans, and invertograms were done. Patients were resuscitated, and Pena's posterior sagittal anorectoplasty (PSARP) done in prone positions. Two-ml syringe vents were inserted into the new anus for 10 days. Cephalosporin and metronidazole were given as peri-operative antibiotics. Results: All patients had intermediate anomalies. There were no other major associated congenital anomalies. Urethral catheter could not be inserted in one patient. One patient presented with septicaemia and jaundice. He was deemed too ill to withstand a major operation. These 2 patients therefore had diverting colostomies. There were no problems with posterior sagittal anorectoplasty in the other 3 patients. The father of one patient discharged him against medical advice on the 5 th postoperative day. The mother had post-partum haemorrhage and they went for traditional treatment because they could not provide blood donors. The skin wound of 2 patients healed completely at removal of stitches. Both are having monthly dilatations 9months and 1 year post-operatively.Conclusion: This preliminary study shows that it is feasible for males with intermediate imperforate anus to have safe posterior sagittal anorectoplasty without colostomy. The advantages of one, instead of 3 major operations, are many, especially in developing countries. If this result can be reproduced in high anomalies colostomy may be unnecessary in many cases of anorectal malformations with a lot of benefits to these unfortunate children and their poor families.

Primary perineal surgeries for the low and intermediate anorectal anomalies: 5‐year results in a developing country

“…The importance of colostomy created for fecal diversion in the repair of anorectal anomaly cannot be overemphasized despite many associated complications previously described 4,5,12 . Repair of low and intermediate anorectal anomalies without the use of a prior colostomy was successful in 27 (93.1%) of our series with one revision and one mortality due to sepsis, which was similar to results from previous studies 1,8–10 . Congenital anorectal anomaly was common during the study period and accounted for 15.6% of 263 indications for gastrointestinal operation in children.…”

“…The low types were more prone to post‐repair constipation which improved during follow up with no fecal incontinence recorded despite the initial fecal soilage recorded in some patients. Sepsis‐related complications were high in this study especially among the neonates and, despite the use of adequate broad‐spectrum antibiotics, one child developed multiple organ failure and died on the third day after operation which was a similar outcome to previous anorectal surgery in this subregion 1–3 …”

“…4,5,12 Repair of low and intermediate anorectal anomalies without the use of a prior colostomy was successful in 27 (93.1%) of our series with one revision and one mortality due to sepsis, which was similar to results from previous studies. 1,[8][9][10] Congenital anorectal anomaly was common during the study period and accounted for 15.6% of 263 indications for gastrointestinal operation in children. The low lesion accounted for a large proportion of cases and these findings tally with earlier reports 2,3 in sub-Saharan Africa.…”

“…Anorectal operations are frequently carried out in children for congenital and acquired conditions. Although congenital anorectal anomaly constitutes a significant cause of neonatal intestinal obstruction and indication for anorectal surgery in this African subregion, little is known about the frequency of acquired anorectal conditions 1–3 . Corrective anorectal surgeries for congenital anorectal anomaly are challenging, especially in developing countries.…”

“…Although congenital anorectal anomaly constitutes a significant cause of neonatal intestinal obstruction and indication for anorectal surgery in this African subregion, little is known about the frequency of acquired anorectal conditions. [1][2][3] Corrective anorectal surgeries for congenital anorectal anomaly are challenging, especially in developing countries. This is due to late presentation and lack of facilities which necessitate the creation of a prior colostomy that is required for fecal diversion.…”