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

Abstract

Aim:The late presentation of clinically unstable children with anorectal anomaly requires the creation of a prior colostomy. The objective of the present study was to examine the feasibility and applicability of primary perineal surgeries for low and intermediate anorectal anomalies without a prior colostomy. Methods: A 5-year experience with consecutive cases of children that had primary perineal surgeries for low/intermediate anorectal anomaly at Results: A total of 29 children aged between 1 day and 3 years (mean 5.4 months Ϯ 2.7), comprising 17 males and 12 females with a male/female ratio of 1.4:1 had primary perineal surgeries for low 19 (65.5%) and intermediate 10 (34.5%) anorectal anomalies. They accounted for 15.6% of children who underwent gastrointestinal operations, and diagnosis was mainly clinical in the majority of them. Transposition anorectoplasty done in 19 (65.5%) children was the commonest procedure, followed by anterior perineal anorectal pullthrough in six (20.7%) and cutback anoplasty in four (13.8%). Anal stenosis which responded to serial dilatation was the main complication and it was statistically significant for the intermediate group compared to the low group (P < 0.0002). More children among the low group had recurrent constipation, although no significant statistical difference was observed when this was compared (P < 0.6451). Overall, 27 (93.1%) children, comprising 18 low and nine intermediate lesions, were successfully managed whereas one (3.4%) child with intermediate lesion had revision surgery with one (3.4%) mortality recorded due to sepsis. Conclusion: Primary perineal surgeries without a prior colostomy in children with low and intermediate anorectal anomaly were feasible, applicable and should be used in our setting.

Outcome of primary posterior sagittal anorectoplasty of high anorectal malformation in well selected neonates

“…[1][2][3] The fifty children managed with anorectal malformations accounted for a large proportion of pediatric surgical workload during the period as also reported in previous similar studies in the subregion. [6,16] Of the children diagnosed with high ARM who had PSARP, only five (16%) met the locally adapted inclusion criteria for primary PSARP. The few cases included in the study were chiefly influenced by late presentation of affected babies who were in severe clinical derangements that could pose serious challenges to neonatal anesthesia in a setting with inadequate pediatric surgical facilities.…”

“…Vomiting and aspiration, even with nasogastric tube in-situ, were earlier noted as major drawbacks to jack-knife positioning for PSARP. [1,2,6,16] Consequently, babies who presented after the first week of life, diagnosed with associated life threatening congenital anomaly (especially cardiac), has gross abdominal distension with splinted diaphragm, aspirated before presentation with clinical evidence of sepsis, poor renal status, and derangement in hemogram and blood chemistry, were excluded from the study and offered conventional PSARP. [2,3,13] Centers [9,14,15,17,20] in developed countries included and reported encouraging results with much larger series.…”

“…[6] Hence, apart from reports on primary repair of low and intermediate ARM, not many studies have been done on primary PSARP for high ARM in neonates in this subregion. [6,16] Over four years, locally adapted inclusion criteria for primary PSARP in neonates with high ARM were adopted in a Nigerian referral pediatric surgical center to evaluate the feasibility and safety in this subregion. The aim of this paper is to report the outcome recorded and the experiences gained, which may be useful to surgeons in similar settings.…”