Treatment of Children with Anorectal Malformations—10-Year Review

Abstract

Introduction: Anorectal malformations include a wide spectrum of congenital defects of the anus, anal canal and rectum, which are often combined with urogenital tract defects. They are often associated with congenital anomalies of other organ systems such as genitourinary, cardiovascular, digestive, skeletal, etc. Objectives: This study aimed to review the patients with anorectal malformations, diagnosis, different types of associated anomalies and their frequency, modalities of treatment, results of treatment and complications. Materials and Methods: Since 2010, we have performed a combined retrospective and prospective analysis of a total of 76 patients with anorectal malformations which were diagnosed and treated at our clinic between 2005 and 2014. Results: Of 76 patients with anorectal malformations, 48 were male (63.16%) and 28 female (36.84%). Anal stenosis was the commonest type (30.26%) followed by ARM without fistula (25.00%) and rectourethral fistula (18.42%). The most common associated anomalies were urogenital (49.12%), cardiovascular (21.05%), gastrointestinal (15.79%), and bone malformations (5.26%). 34 patients (44.74%) were treated primarily without colostomy. In 40 patients (52.63%) colostomy was performed after birth. PSARP was the procedure of choice in 76.92% of patients. 7 patients (9.21%) died in total. Constipation was present in 52.38% of all patients. Patients older than 3 years of age totally continent were 30.91%. Redo operations were performed in 5 patients (7.94%). Conclusion: Early diagnosis of anorectal malformations is very important. Some malformations such as anal stenosis are sometimes diagnosed beyond the neonatal age. Challenging problem still remains high percentage of children that suffer from fecal incontinence and constipation.