Analysis of postoperative complications in patients undergoing anorectal malformation surgery: are there any predisposing factors?

Abstract

Objective: To describe our experience with anorectal malformation (ARM) patients, while analyzing complications and risk factors.

Materials and methods: A retrospective study of ARM patients aged 0-18 years old undergoing surgery from 2006 to 2023 was carried out. Demographic variables, associated malformations, age and repair surgery operating times, presence and type of colostomy, previous intestinal preparation, and presence and type of surgical complications -intestinal occlusion, anal prolapse, stenosis, bleeding, dehiscence, extrusion, anoplasty misposition, urethral perforation, and stomal complications- were collected.

Results: 89 patients were studied. 44 patients were boys and 45 were girls. Median age was 7 years (3-18). Baseline treatment was posterior sagittal anorectoplasty (PSARP) in 61 (69%) patients, and colostomy in 24 (27%) patients (4/24 loop, 1/24 Hartmann, 19/24 divided ends). Median age at PSARP was 5.4 months (5 days-7 years), with a mean operating time of 112 min (38-259). The incidence of complications was 38% (34/89). The most frequent complication was anal prolapse (19%) (1/3 reintervention as a result of pain/bleeding), followed by dehiscence (17%). Statistically significant differences were noted between intestinal preparation (p= 0.001, -1.49 95% CI: -2.69 to -1.24), presence of colostomy (p= 0.05, -2,54 95% CI: -6.5 to -0.987), and age at surgical repair (p= 0.047, 1.198 95% CI: 1.1 to 3.15) with the incidence of complications. The age-complications correlation score was 0.21 (p= 0.046). No differences in terms of operating time (p= 0.073) and type of colostomy (p= 0.81) were observed.

Conclusions: 38% of the patients had complications. Intestinal preparation, presence of colostomy, and age at repair can have an impact on the incidence of complications. The first two could stand as protective factors (RR= -1,49 and -2.54, respectively). Age would increase the risk by 1.2-fold.