Long term bowel function after repair of anorectal malformations in Uganda
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Read the article on jpedsurg.org ↗Article · Dec 2019 · 1 min read
In brief
In brief
Ugandan children with anorectal malformations achieve 65% normal/good long-term bowel function despite delayed repair (median 2.3 years) and prolonged colostomy duration (1.8 years), comparable to high-income country outcomes. Nearly half experience soiling and significant rates of incontinence persist, suggesting need for improved postoperative follow-up protocols.
Written by the GCMD Library team from the article.
Background
Anorectal malformations (ARMs) are common congenital anomalies cared for at Mulago Pediatric Surgery Unit (PSU), similar to other sites in the region. All patients undergo staged repairs and complete treatment at older ages compared to high-income countries (HICs). This is the first study to examine long-term bowel function in our patients and compare with HICs.
Methods
A retrospective cohort study was conducted of all children 3–12 years old with ARMs who had repair between January 2012 and June 2017 and who completed surgical repair at least 6 months prior to the study. Bowel function was measured using the fecal continence scoring system derived from Rintala and Lindahl (1995). As in prior studies, patients were classified by score into four categories: Poor (6–9); Fair (9–11); Good (12–17); and Normal (18–20).
Results
Median follow up was 2 years post stoma closure. Long-term bowel function was Normal/Good in 65% (C.I 27, 45), and Fair/Poor 35% (C.I 55, 73), with soiling in 49% (C.I 40, 59), constipation in 23% (C.I 16, 32); and incontinence in 39% (C.I 30, 39). There was no statistically significant association between bowel function and multiple demographic, social, and clinical factors. Median age at completion of treatment (stoma reversal) was 2.3 years old, and median duration of colostomy (interval between stoma placement and takedown) was 1.8 years.
Conclusion
Despite definitive repair at older age and almost two years of living with a stoma, our patients achieve fair long-term bowel function. Nonetheless, improved follow up and timely management of complications may improve outcomes soiling, incontinence and constipation.
Level of evidence
Level II.