Anorectal malformation: Audit of management in a major tertiary institution in Ghana

Abstract

BackgroundAnorectal malformation (ARM) remains a significant challenge to the child and paediatric surgeons. Its rarity is relative in Sub-Saharan Africa, where there are few specialized centres for management. This study aimed to describe the presentations, management, and preliminary outcomes of ARM in a major specialized centre. MethodsA prospective observational study, with a two-year follow-up was conducted for children (up to 15 years) who presented with ARM at the Paediatric Surgery Unit between November 2020 and July 2021. ResultsSixty-one (61) patients (M: F = 1:0.96) were studied. 28.27 % of the ARM's were detected on day one of birth. More than two thirds of the cohort (70.5 %) was first detected by mothers. The remainder (29.5 %) were detected by health professionals. Majority, 88.2 %, presented late (>24hours). 34(55.4 %) presented in a stable state, 20(32.79 %) with acute intestinal obstruction and 4(6.56 %) with sepsis. Associated congenital anomalies were observed in 7(11.48 %) of patients. All the children had a staged procedure (colostomy, PSARP and closure of colostomy). The mean duration between colostomy creation and PSARP was 7.02 +/- 2.05 months, while the mean duration between PSARP and colostomy reversal was eight months. The complication and mortality rates after all the staged procedures were 39.3 % and 2.2 %, respectively. 5.2 % had persistent faecal soiling while 3.5 % had persistent constipation at 2 years. There were no anal strictures or rectal prolapse. ConclusionSurgical outcomes of children with ARM are generally good, although there were late and unstable presentations to the hospital. Late identification of ARM by health professionals lead to late presentation.