Th Management and Complications of Staged Approach in Children with  Anorectal Malformations; Experience at Tertiary Care Facility

Abstract

Objective: To present the data of children with anorectal malformations treated with a staged approach, including the complications of each stage. Study Design: Prospective longitudinal Study Place and Duration of Study: Paediatric Surgery Departments, Combined Military Hospital, Malir and Multan, Pakistan from Jan 2017 to Jun 2019 and Jul 2019 to Jul 2022, respectively. Methodology: Twenty-four children with anorectal malformations were included. All were treated with a staged approach. The complications encountered during each approach were documented. Results: A total of 24 patients were operated on. Fourteen (58.3%) were female, whereas 10 (41.7%) were male patients. The age range was 1-4 years, with a mean of 2.00 ± 0.97 years. Female patients had an ARM with a rectovestibular fistula. Two (20%) of the male patients had rectal atresia, a recto-urethral bulbar fistula, a recto-urethral prostatic fistula, a recto-bladder neck fistula, or a perineal fistula. Two (8.3%), three (12.5%), two (8.3%), and one (4.1%) patients who had stage 1 had stomal stenosis or retraction, wound dehiscence, wound infection, and stoma prolapse respectively. In the second stage, two patients (8.3% of all patients) had an infection, a wound dehiscence, a dehiscence of the perineal body, and anal stenosis. In the other patient, one (4.1%) had an anal mucosal prolapse and severe urethral injury. After stage 3, only one patient (4.1%) had a wound infection. Conclusion: Patients with ARM are generally treated with a multistaged approach, and each stage of treatment has its own complications.

Keywords

• Anoplasty, Anorectal malformations, Rectovestibular fistula.