Management of Anorectal Malformations: A Five-Year Experience from a Tertiary Care Center of Southern Iraq

Background: Anorectal malformations are frequently observed congenital anomalies in pediatric surgical patients, affecting the gastrointestinal tract. The purpose of this study is to examine the prevalence, demographic characteristics, types, and modes of presentation of anorectal malformations in our society. Additionally, we aim to estimate the presence of associated anomalies and postoperative complications. Methods: A retrospective study was conducted on all cases of anorectal malformations admitted to our pediatric surgery center between December ۲۰۱۷ and December ۲۰۲۲. A total of ۱۰۴ patients were included in the study. The study examined information related to demographics, clinical presentation, and treatment outcomes. Results: The incidence of anorectal malformations was ۱.۰۲۹ per ۵۰۰۰ live births, with a male to female ratio of ۲:۱. Early presentations, occurring within the first ۳ days of life, were observed in ۸۵.۵% of male patients and ۳۷.۱% of female patients. A history of prematurity was found in ۱۴.۵% of male patients and ۲۰% of female patients. The most common type of anorectal malformation in male patients was rectourethral fistula (۶۳.۸%), while in female patients, it was rectovestibular fistula (۶۵.۷%). Associated anomalies were present in ۴۱.۳% of patients, with genitourinary anomalies being the most common (۱۰.۶%). Initial treatment included an initial colostomy and posterior sagittal anorectoplasty in ۸۷ (۸۳.۷%) patients, while only ۱۶.۳% of patients underwent minimal anoplasty. Postoperative complications were reported in ۴۷% of patients, with constipation being the most prevalent (۴۵.۲%), followed by incontinence (۳۷.۵%). Conclusion: Anorectal malformations are quite common in our society, with boys being affected nearly twice as often as girls. Unfortunately, the diagnosis in female patients is often delayed. Additionally, a high incidence of associated anomalies has been recorded. Constipation is the most frequently observed late complication. However, the majority of patients do experience acceptable outcomes in terms of continence.

کلیدواژه ها:

Anorectal malformations ، Anorectoplasty ، Imperforate anus ، Incontinence