SURGICAL OUTCOMES OF ANORECTAL MALFORMATIONS IN PEDIATRIC PATIENTS: A SINGLE-CENTER EXPERIENCE
Main Article Content
Keywords
Anorectal malformations, pediatric surgery, posterior sagittal anorectoplasty, surgical outcomes, congenital anomalies, postoperative care, functional outcomes.
Abstract
Background: Anorectal malformations (ARMs) are associated with congenital abnormality of the anus and rectum in most cases needs surgical repair. As different types of malformation, their association with other anomalies, and the timing of the surgery, the management and outcomes of ARMs also differ.
Objective: This study was aimed to assess the results of surgeries of children diagnosed with ARMs.
Methods: A descriptive cross-sectional study was conducted for about 3 months from Aug, 2011 to Oct, 2011 in the Department of Paediatric Surgery, Khalifa Gulnawaz Teaching Hospital, Bannu Medical College, Bannu, Pakistan. Sixty pediatric patients with ARMs and who received intervention through surgery were enrolled. Patients’ information regarding age, gender, BMI, presenting symptoms, concomitant anomalies, operative procedures and early complications were obtained. Descriptive statistics and Analysis of Variance (ANOVA) were used to determine if there were statically significant differences between variables of interest with the level of significant set to 0.05 or less.
Results: Regarding the type of malformations: The most frequent type was the intermediate type (42%), second was the low type (33%) and the last was the high type (25%). Secondary features were seen in 60% of patients and ductal malformations dominated the genitourinary (25%). With regards to the surgical repair, posterior sagittal anorectoplasty (PSARP) was done in 58% of patients with a staged surgery done in 67% of the cases. The average hospitalization was 5.6 days, and the early postoperative complications were generally mild. Long-term follow-up revealed that 80% of patients achieved continence, although 17% experienced constipation and 13% had soiling. Reoperation was required in 8% of cases, and the mortality rate was 3%, primarily due to septicemia.
Conclusion: This study discusses better outcomes of ARMS, especially with PSARP and focuses on the necessity of early detection, comprehensive preoperative planning, and appropriate postoperative management. ‘Persistent functional issues such as constipation and soiling emphasize the need for long-term follow-up and bowel management programs’. ‘These findings provide valuable insights into ARM management and can inform future strategies to optimize outcomes in similar clinical settings’.
Objective: This study was aimed to assess the results of surgeries of children diagnosed with ARMs.
Methods: A descriptive cross-sectional study was conducted for about 3 months from Aug, 2011 to Oct, 2011 in the Department of Paediatric Surgery, Khalifa Gulnawaz Teaching Hospital, Bannu Medical College, Bannu, Pakistan. Sixty pediatric patients with ARMs and who received intervention through surgery were enrolled. Patients’ information regarding age, gender, BMI, presenting symptoms, concomitant anomalies, operative procedures and early complications were obtained. Descriptive statistics and Analysis of Variance (ANOVA) were used to determine if there were statically significant differences between variables of interest with the level of significant set to 0.05 or less.
Results: Regarding the type of malformations: The most frequent type was the intermediate type (42%), second was the low type (33%) and the last was the high type (25%). Secondary features were seen in 60% of patients and ductal malformations dominated the genitourinary (25%). With regards to the surgical repair, posterior sagittal anorectoplasty (PSARP) was done in 58% of patients with a staged surgery done in 67% of the cases. The average hospitalization was 5.6 days, and the early postoperative complications were generally mild. Long-term follow-up revealed that 80% of patients achieved continence, although 17% experienced constipation and 13% had soiling. Reoperation was required in 8% of cases, and the mortality rate was 3%, primarily due to septicemia.
Conclusion: This study discusses better outcomes of ARMS, especially with PSARP and focuses on the necessity of early detection, comprehensive preoperative planning, and appropriate postoperative management. ‘Persistent functional issues such as constipation and soiling emphasize the need for long-term follow-up and bowel management programs’. ‘These findings provide valuable insights into ARM management and can inform future strategies to optimize outcomes in similar clinical settings’.
References
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2. Suomalainen A, Wester T, Koivusalo A, Rintala RJ, Pakarinen MP. Congenital funnel anus in children: associated anomalies, surgical management and outcome. Pediatric surgery international. 2007;23:1167-70.
3. Hartman EE, Oort FJ, Aronson DC, Hanneman MJ, van Heurn E, de Langen ZJ, et al. Explaining change in quality of life of children and adolescents with anorectal malformations or Hirschsprung disease. Pediatrics. 2007;119(2):e374-e83.
4. Youssef NN, Pensabene L, Barksdale Jr E, Di Lorenzo C. Is there a role for surgery beyond colonic aganglionosis and anorectal malformations in children with intractable constipation? Journal of pediatric surgery. 2004;39(1):73-7.
5. Hartman EE, Sprangers MA, Visser MR, Oort FJ, Hanneman MJ, van Heurn LWE, et al. Anorectal malformations: does healthcare meet the needs? Journal of pediatric gastroenterology and nutrition. 2005;41(2):210-5.
6. Makin EC, Hyett J, Ade-Ajayi N, Patel S, Nicolaides K, Davenport M. Outcome of antenatally diagnosed sacrococcygeal teratomas: single-center experience (1993-2004). Journal of pediatric surgery. 2006;41(2):388-93.
7. Goyal A, Williams JM, Kenny SE, Lwin R, Baillie CT, Lamont GL, et al. Functional outcome and quality of life in anorectal malformations. Journal of pediatric surgery. 2006;41(2):318-22.
8. Hamid C, Holland A, Martin H. Long-term outcome of anorectal malformations: the patient perspective. Pediatric surgery international. 2007;23:97-102.
9. Levitt MA, Peña A. Anorectal malformations. Orphanet journal of rare diseases. 2007;2(1):33.
10. Davies MC, Creighton SM, Wilcox DT. Long-term outcomes of anorectal malformations. Pediatric Surgery International. 2004;20:567-72.
11. Peña A, Hong A. Advances in the management of anorectal malformations. The American journal of surgery. 2000;180(5):370-6.
12. Holschneider AM, Hutson JM. Anorectal malformations in children: embryology, diagnosis, surgical treatment, follow-up: Springer Science & Business Media; 2006.
13. Bhargava P, Mahajan J, Kumar A. Anorectal malformations in children. Journal of Indian association of pediatric surgeons. 2006;11(3):136-9.
14. Archibong A, Idika I. Results of treatment in children with anorectal malformations in Calabar, Nigeria: paediatric surgery. South African Journal of Surgery. 2004;42(3):88-90.
15. Cho S, Moore SP, Fangman T. One hundred three consecutive patients with anorectal malformations and their associated anomalies. Archives of pediatrics & adolescent medicine. 2001;155(5):587-91.
16. Liu G, Yuan J, Geng J, Wang C, Li T. The treatment of high and intermediate anorectal malformations: one stage or three procedures? Journal of pediatric surgery. 2004;39(10):1466-71.
17. Stoll C, Alembik Y, Dott B, Roth M. Associated malformations in patients with anorectal anomalies. European journal of medical genetics. 2007;50(4):281-90.
18. Kumar A, Agarwala S, Srinivas M, Bajpai M, Bhatnagar V, Gupta D, et al. Anorectal malformations and their impact on survival. The Indian Journal of Pediatrics. 2005;72:1039-42.
19. Shaul DB, Monforte HL, Levitt MA, Hong AR, Peña A. Surgical management of perineal masses in patients with anorectal malformations. Journal of pediatric surgery. 2005;40(1):188-91.
20. Ratan SK, Rattan KN, Pandey RM, Mittal A, Magu S, Sodhi PK. Associated congenital anomalies in patients with anorectal malformations—a need for developing a uniform practical approach. Journal of pediatric surgery. 2004;39(11):1706-11.
21. Levitt MA, Peña A. Outcomes from the correction of anorectal malformations. Current opinion in pediatrics. 2005;17(3):394-401.
22. Senel E, Demirbag S, Tiryaki T, Erdogan D, Cetinkursun S, Cakmak O. Postoperative anorectal manometric evaluation of patients with anorectal malformation. Pediatrics International. 2007;49(2):210-4.
23. Bai Y, Yuan Z, Wang W, Zhao Y, Wang H, Wang W. Quality of life for children with fecal incontinence after surgically corrected anorectal malformation. Journal of pediatric surgery. 2000;35(3):462-4.
2. Suomalainen A, Wester T, Koivusalo A, Rintala RJ, Pakarinen MP. Congenital funnel anus in children: associated anomalies, surgical management and outcome. Pediatric surgery international. 2007;23:1167-70.
3. Hartman EE, Oort FJ, Aronson DC, Hanneman MJ, van Heurn E, de Langen ZJ, et al. Explaining change in quality of life of children and adolescents with anorectal malformations or Hirschsprung disease. Pediatrics. 2007;119(2):e374-e83.
4. Youssef NN, Pensabene L, Barksdale Jr E, Di Lorenzo C. Is there a role for surgery beyond colonic aganglionosis and anorectal malformations in children with intractable constipation? Journal of pediatric surgery. 2004;39(1):73-7.
5. Hartman EE, Sprangers MA, Visser MR, Oort FJ, Hanneman MJ, van Heurn LWE, et al. Anorectal malformations: does healthcare meet the needs? Journal of pediatric gastroenterology and nutrition. 2005;41(2):210-5.
6. Makin EC, Hyett J, Ade-Ajayi N, Patel S, Nicolaides K, Davenport M. Outcome of antenatally diagnosed sacrococcygeal teratomas: single-center experience (1993-2004). Journal of pediatric surgery. 2006;41(2):388-93.
7. Goyal A, Williams JM, Kenny SE, Lwin R, Baillie CT, Lamont GL, et al. Functional outcome and quality of life in anorectal malformations. Journal of pediatric surgery. 2006;41(2):318-22.
8. Hamid C, Holland A, Martin H. Long-term outcome of anorectal malformations: the patient perspective. Pediatric surgery international. 2007;23:97-102.
9. Levitt MA, Peña A. Anorectal malformations. Orphanet journal of rare diseases. 2007;2(1):33.
10. Davies MC, Creighton SM, Wilcox DT. Long-term outcomes of anorectal malformations. Pediatric Surgery International. 2004;20:567-72.
11. Peña A, Hong A. Advances in the management of anorectal malformations. The American journal of surgery. 2000;180(5):370-6.
12. Holschneider AM, Hutson JM. Anorectal malformations in children: embryology, diagnosis, surgical treatment, follow-up: Springer Science & Business Media; 2006.
13. Bhargava P, Mahajan J, Kumar A. Anorectal malformations in children. Journal of Indian association of pediatric surgeons. 2006;11(3):136-9.
14. Archibong A, Idika I. Results of treatment in children with anorectal malformations in Calabar, Nigeria: paediatric surgery. South African Journal of Surgery. 2004;42(3):88-90.
15. Cho S, Moore SP, Fangman T. One hundred three consecutive patients with anorectal malformations and their associated anomalies. Archives of pediatrics & adolescent medicine. 2001;155(5):587-91.
16. Liu G, Yuan J, Geng J, Wang C, Li T. The treatment of high and intermediate anorectal malformations: one stage or three procedures? Journal of pediatric surgery. 2004;39(10):1466-71.
17. Stoll C, Alembik Y, Dott B, Roth M. Associated malformations in patients with anorectal anomalies. European journal of medical genetics. 2007;50(4):281-90.
18. Kumar A, Agarwala S, Srinivas M, Bajpai M, Bhatnagar V, Gupta D, et al. Anorectal malformations and their impact on survival. The Indian Journal of Pediatrics. 2005;72:1039-42.
19. Shaul DB, Monforte HL, Levitt MA, Hong AR, Peña A. Surgical management of perineal masses in patients with anorectal malformations. Journal of pediatric surgery. 2005;40(1):188-91.
20. Ratan SK, Rattan KN, Pandey RM, Mittal A, Magu S, Sodhi PK. Associated congenital anomalies in patients with anorectal malformations—a need for developing a uniform practical approach. Journal of pediatric surgery. 2004;39(11):1706-11.
21. Levitt MA, Peña A. Outcomes from the correction of anorectal malformations. Current opinion in pediatrics. 2005;17(3):394-401.
22. Senel E, Demirbag S, Tiryaki T, Erdogan D, Cetinkursun S, Cakmak O. Postoperative anorectal manometric evaluation of patients with anorectal malformation. Pediatrics International. 2007;49(2):210-4.
23. Bai Y, Yuan Z, Wang W, Zhao Y, Wang H, Wang W. Quality of life for children with fecal incontinence after surgically corrected anorectal malformation. Journal of pediatric surgery. 2000;35(3):462-4.
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Published
Apr 25, 2012
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How to Cite
Muhammad Jehangir Khan. (2012). SURGICAL OUTCOMES OF ANORECTAL MALFORMATIONS IN PEDIATRIC PATIENTS: A SINGLE-CENTER EXPERIENCE. Journal of Population Therapeutics and Clinical Pharmacology, 19(1), 100-106. https://doi.org/10.53555/ndf5ca69
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Author Biography
Muhammad Jehangir Khan
Associate Professor, Department of Paediatric Surgery, Khalifa Gulnawaz Teaching Hospital, Bannu Medical College, Bannu, Pakistan.
How to Cite
Muhammad Jehangir Khan. (2012). SURGICAL OUTCOMES OF ANORECTAL MALFORMATIONS IN PEDIATRIC PATIENTS: A SINGLE-CENTER EXPERIENCE. Journal of Population Therapeutics and Clinical Pharmacology, 19(1), 100-106. https://doi.org/10.53555/ndf5ca69