Patterns and treatment outcomes of anorectal malformations in Mbarara Regional Referral Hospital, Uganda
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In brief
In brief
Retrospective study of 78 ARM patients in Uganda showing 63% presented late (>48h after birth), with vestibular fistula most common overall and rectourethral fistula most common in males. Despite delayed definitive surgery (median 11 months) and resource constraints, continence outcomes were good (62.5% in patients ≥3 years), though 20% had associated anomalies with increased mortality risk.
Written by the GCMD Library team from the article.
Background/purpose
Anorectal malformation (ARM) is a common condition. Owing to scarcity of pediatric surgery services in Uganda, however, relatively little is known about this condition.
Methods
This was a retrospective review of medical records of all patients admitted to Mbarara Regional Referral Hospital (MRRH) from January 2014 to May 2016. MRRH serves 3–8 million people in southwest Uganda. We also enrolled patients prospectively from June 2016 to December 2016.
Results
78 patients were enrolled in the study. 63.38% had delayed diagnosis (presenting >48 h after birth), and most of these were self-referrals from home. The most common malformation was a vestibular fistula. Associated congenital anomalies were seen in 20% of patients, and this was associated with increased mortality. These anomalies included limb, eye, ear and genitourinary anomalies as well as ventricular septal defects, patent ductus arteriosus, spina bifida and tracheoesophageal fistula. Posterior sagittal anorectoplasty (PSARP) was the definitive surgery used. It was performed in 58.97% of the patients. Median age of patients who underwent PSARP was 11 months. 73.91% of PSARP patients had their colostomies closed and 62.5% of these who were ≥3 years old had good continence outcomes. Overall mortality rate was 8.97%.
Conclusion
The majority of patients are diagnosed late. Vestibular fistula is the overall most common type of ARM. In males, however, rectourethral fistula is the most common type. Definitive surgery at MRRH is performed late. Continence outcomes are good and comparable to other countries with more resources.
Level of evidence
III.