A review of the trend in the management of anorectal malformation in a major pediatric surgical center in India

Abstract

Background: Anorectal malformation is a common cause of intestinal obstruction in children. Anorectal malformation is a common congenital defect and its management has evolved over the years. Most of the patients presented as newborns to the emergency department. This is because anorectal malformation commonly presents with intestinal obstruction which is an emergency, patients frequently presented late with marked abdominal distension.Aims and Objectives: This is a retrospective and prospective review of medical records, operation registers and operation notes of patients managed for anorectal malformation at SMS Medical college and hospital in department of pediatrics surgery from June 2021 to June 2023. The main aim of this study is ‘’a review of the trend in the management of anorectal malformation in a major pediatric surgical center in India’’. Materials and Methods: A retrospective and prospective analysis of 590 patients with anorectal malformations managed from June 2021 to June 2023 was carried out. Demographic data, type of anomaly, mode of presentation, evaluation, treatment and outcome of treatment were obtained. Total 590 patients data recorded. Data obtained were analysed using SPSS version 11.0. The 𝛘2 test was used to test for level of statistical significance. Level of statistical significance was set at 0.05.Results: From this study we found that- There were a total 590 patients (376 boys and 214 girls). The median age at first surgery was 8 days (range 1 day–9 years). There were 358 emergency operations in and 232 elective operations were done. The main investigations for evaluation were a lateral cross table X-ray, abdominal ultrasonography, sacral X-ray, echocardiography and a distal cologram. Total 330 patients requiring colostomy had a transverse loop colostomy. 14 patients with recto-vestibular fistula were given a colostomy before the definitive surgery, while 28 patients with recto-vestibular fistula were managed without a colostomy. The definitive surgery done in 70 [30.14%] were cutback anoplasty, sacro-abdomino-perineal pull through 12 [5.17%], posterior sagittal ano-rectoplasty [PSARP] 104 [44.8%], anal dilatation 34 (14.6%), cruciate incision 8 (3.4%) and posterior sagittal ano-recto-vagino-urethroplasty (PSARVUP) 4 (1.72%) were done. Early complications were colostomy related. The early complication rate was 14% (46 of 330). Most common complications are bowel evisceration 30.4%, surgical site infection 26%, stoma necrosis 13%, stoma stenosis 13%and stoma retraction 8.69% were found. Late complications following definitive treatment were: faecal incontinence 5 (4.3%), anal stenosis 70 (60.34%), rectal retraction 18 (15.5%), mucosal prolapse 20 (17.24%) and faecal soilage 3 (2.58%). Cause of death were 18 [3%] in which main causes are- anaesthetic deaths 2 (11.1%), overwhelming sepsis 4 (22.2%), dys-electrolytaemia 4 (22.2%) and nonspecific 8 (44.4%).Conclusion: There have been significant changes in the management of anorectal malformations in this center, resulting in improved outcomes. This has been due to better understanding of the pathological condition and refinements in the surgical treatment.