Anorectal malformations: Early outcome analysis in a tertiary care center in India

Priya Mathew,Rahul Gupta,Dharmesh Sharma,Arun Kumar Gupta

doi:10.47338/jns.v10.927

Priya Mathew, Rahul Gupta + Show 2 more

Open Access

https://doi.org/10.47338/jns.v10.927

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Abstract

Background: Delayed diagnosis, referral, and presence of associated anomalies may influence the outcome of Anorectal malformations (ARM). The aim of this study was to analyze the early outcomes (1 month postoperatively) of ARM presenting in the neonatal period. Methods: A prospective study was carried out in our tertiary care teaching institute from December 2018 to March 2020. All neonates admitted in the NICU with ARM were studied. Results: There were 315 neonates; out of these, 236 (74.92%) were male and 79 (25.07%) were female. High ARM (HARM) was present in 265 (84.13%) and low ARM (LARM) in 50 (15.87%). Associated congenital anomalies were noted in 121 (38.41%). Major associated anomalies consisted of gastrointestinal (GIT) (41.32%), oesophageal (31.4%), and genitourinary (GU) (19.83%). Out of 306 procedures for ARM, 196 (64.05%) neonates underwent left transverse colostomy (LTC). The most frequent postoperative complications were thrombocytopenia (115) followed by sepsis (98). Colostomy prolapse was uncommon (2). The overall mortality was 87/315 (27.61%) neonates - 82/265 (30.94%) in HARM and 5/50 (10%) in LARM. Neonatal mortality was significantly high with birth weight <2500gm 55/153 (35.94%; p value= 0.0001), associated malformations 82 (67.76%, p value= 0.003); and delayed presentation 40/87 (45%), and with primary perforation 5/6 (83.33%). Conclusions: Higher mortality was associated with low birth weight, double/ triple atresia, neonatal GIT perforation, sepsis on admission, and those with oesophageal and cardiac anomalies. More than 1/3rd (38.41%) patients had associated anomalies; thus, a detailed systematic evaluation of all subtypes is paramount.

Highlights

IntroductionLow birth weight, delay in access to pediatric surgeons, septicemia, gut perforation have an adverse impact on the prognosis
Anorectal malformations (ARM’s) are a diverse group of congenital anomalies encompassing the lower gastrointestinal tract, urinary, and /or genital system.[1,2] ARM has an incidence of 1:5000 live births.[1,2] According to Peña and Bechit, ARM has a varied presentation, ranging from low perineal fistula to high anomalies with complex surgical management.[1,3] It is frequently associated with anomalies affecting other organ systems referred to as the VACTERL association (5% to 31%).[4,5]Complex associated anomalies, low birth weight, delay in access to pediatric surgeons, septicemia, gut perforation have an adverse impact on the prognosis
Major associated anomalies consisted of gastrointestinal (GIT) (41.32%), oesophageal (31.4%), and genitourinary (GU) (19.83%)

Summary

Introduction

Low birth weight, delay in access to pediatric surgeons, septicemia, gut perforation have an adverse impact on the prognosis. Risk factors such as hypothermia, hypoglycemia, poor immunity, and sepsis are modifiable and can lead to a reduction in neonatal mortality.[6] Timely diagnosis, management of associated anomalies, efficient surgical repair provide the best chance for a good functional outcome in patients.[7] We aimed to analyze the early outcomes (morbidity and mortality statistics) of a cohort of patients of ARM presenting in the neonatal period in a high-volume tertiary care teaching institute from the north-western region of India. The aim of this study was to analyze the early outcomes (1 month postoperatively) of ARM presenting in the neonatal period

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