Primary perineal surgeries for the low and intermediate anorectal anomalies: 5‐year results in a developing country

Abstract

Aim: The late presentation of clinically unstable children with anorectal anomaly requires the creation of a prior colostomy. The objective of the present study was to examine the feasibility and applicability of primary perineal surgeries for low and intermediate anorectal anomalies without a prior colostomy.Methods: A 5‐year experience with consecutive cases of children that had primary perineal surgeries for low/intermediate anorectal anomaly at the University of Benin Teaching Hospital, Benin City, Nigeria, between January 2003 and December 2007.Results: A total of 29 children aged between 1 day and 3 years (mean 5.4 months ± 2.7), comprising 17 males and 12 females with a male/female ratio of 1.4:1 had primary perineal surgeries for low 19 (65.5%) and intermediate 10 (34.5%) anorectal anomalies. They accounted for 15.6% of children who underwent gastrointestinal operations, and diagnosis was mainly clinical in the majority of them. Transposition anorectoplasty done in 19 (65.5%) children was the commonest procedure, followed by anterior perineal anorectal pullthrough in six (20.7%) and cutback anoplasty in four (13.8%). Anal stenosis which responded to serial dilatation was the main complication and it was statistically significant for the intermediate group compared to the low group (P < 0.0002). More children among the low group had recurrent constipation, although no significant statistical difference was observed when this was compared (P < 0.6451). Overall, 27 (93.1%) children, comprising 18 low and nine intermediate lesions, were successfully managed whereas one (3.4%) child with intermediate lesion had revision surgery with one (3.4%) mortality recorded due to sepsis.Conclusion: Primary perineal surgeries without a prior colostomy in children with low and intermediate anorectal anomaly were feasible, applicable and should be used in our setting.