Management of anorectal malformation: changing trend over two decades in Zaria, Nigeria

ABSTRACT

Background: Anorectal malformation is a common congenital defect and its management has evolved over the years. This is a review of the trend in the management of this condition in a major paediatric surgical centre in Nigeria over two decades. Materials and Methods: A retrospective analysis of 295 patients with anorectal malformations managed from January 1988 to December 2007 was carried out. Results: There were 188 boys and 107 girls aged 1 day-9 years (median 8 years) at presentation. There were 73 (54.5) and 106 (65.8) emergency operations in groups A and B; respectively. There were 61 (45.5) and 55 (34.2) elective operations in groups A and B; respectively. Regarding treatment; in group A; patients requiring colostomy had transverse loop colostomy; while in group B; sigmoid (usually divided) colostomy was preferred. The definitive surgery done during the two periods were group A cutback anoplasty 29 (47.5); anal transplant 5 (8.2); sacroabdominoperineal pullthrough (Stephen's operation) 6 (9.5) and others 21 (34.4). In group B; posterior sagittal anorectoplasty (PSARP) 46 (83.7); anal transplant 1 (1.8); posterior sagittal anorectovaginourethroplasty (PSARVUP) 2 (3.6) and anal dilatation 6 (10.9) were done. Early colostomy-related complication rates were similar in the two groups (P 0.05). The overall late complication rate was 65.5in group A and 16.4in group B (P 0.05). The mortality was 25 (18.6) in group A compared to 17 (10.6) in group B (P 0.05). Conclusion: There have been significant changes in the management of anorectal malformations in this centre in the last two decades; resulting in improved outcomes: