Treatment of Children with Anorectal Malformations—10-Year Review

Sejdi Statovci¹, Hysen Heta², Nexhmi Hyseni¹, Salih Grajçevci¹, Murat Berisha¹, Gani Çeku¹

¹University Clinical Centre of Kosovo, Clinic of Pediatric Surgery, Prishtina, Kosovo.
²Hospital University Centre of Tirana “Mother Teresa” Albania, Tirana, Albania.

DOI: 10.4236/oalib.1101393                

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.

Keywords

Anorectal Malformations, Anal Stenosis, Colostomy, Bowel Management, Children

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Upadhyaya, V.D., Gangopadhyay, A.N., Srivastava, P., Hasan, Z. and Sharma, S.P. (2008) Evolution of Management of Anorectal Malformation through the Ages. The Internet Journal of Surgery, 17, 1.
[2]	Levitt, M.A. and Peña, A. (2010) Imperforate Anus and Cloacal Malformations. In: Holcomb III, G.W. and Murphy, J.P., Eds., Ashcraft’s Pediatric Surgery, 5th Edition, Saunders Elsevier, Philadelphia, 468-490. http://dx.doi.org/10.1016/B978-1-4160-6127-4.00036-7
[3]	Gangopadhyay, A.N. and Pandey, V. (2015) Anorectal Malformations. Journal of Indian Association of Pediatric Surgeons, 20, 10-15. http://dx.doi.org/10.4103/0971-9261.145438
[4]	Holschneider, A., Hutson, J., Peña, A., et al. (2005) Preliminary Report on the International Conference for the Development of Standards for the Treatment of Anorectal Malformations. Journal of Pediatric Surgery, 40, 1521-1526. http://dx.doi.org/10.1016/j.jpedsurg.2005.08.002
[5]	Peña, A. and Hong, A. (2000) Advances in the Management of Anorectal Malformations. The American Journal of Surgery, 180, 370-376. http://dx.doi.org/10.1016/S0002-9610(00)00491-8
[6]	Endo, M., Hayashi, A., Ishihara, M., et al. (1999) Analysis of 1992 Patients with Anorectal Malformations over the Past Two Decades in Japan. Journal of Pediatric Surgery, 34, 435-441.
[7]	Goossens, W.J.H., de Blaauw, I., Wijnen, M.H., de Gier, R.P.E., Kortmann, B. and Feitz, W.F.J. (2011) Urological Anomalies in Anorectal Malformations in The Netherlands: Effects of Screening All Patients on Long-Term Outcome. Pediatric Surgery International, 27, 1091-1097. http://dx.doi.org/10.1007/s00383-011-2959-4
[8]	Sabzehei, M.K., et al. (2011) Urogenital and Other Associated Anomalies in Patients with Anorectal Malformations. Nephro-Urology Monthly, 4, 388-390. http://dx.doi.org/10.5812/numonthly.1678
[9]	Bãlãnescu, R.N., Topor, L. and Moga, A. (2013) Anomalies Associated with Anorectal Malformations. Chirurgia, 108, 38-42.
[10]	Kiely, E.M. and Peña, A. (1998) Anorectal Malformations. In: O’Neill, J.A., Rowe, M.I., Grosfeld, J.L., Fonkalsrud, E.W. and Coran, A.G., Eds., Pediatric Surgery, 5th Edition, St Louis, Mosby, 1425-1448.
[11]	Casaccia, G., Catalano, O.A. and Bagolan, P. (2009) Congenital Gastrointestinal Anomalies in Anorectal Malforma tions: What Relationship and Management? Congenital Anomalies, 49, 93-96. http://dx.doi.org/10.1111/j.1741-4520.2009.00230.x
[12]	Mittal, A., Airon, R.K., Magu, S., Rattan, K.N. and Ratan, S.K. (2004) Associated Anomalies with Anorectal Malformation (ARM). Indian Journal of Pediatrics, 71, 509-514.
[13]	http://dx.doi.org/10.1007/BF02724292
[14]	Albanese, C.T., Jennings, R.W. and Lopoo, J.B. (1999) One-Stage Correction of High Imperforate Anus in the Male Neonate. Journal of Pediatric Surgery, 34, 834-836. http://dx.doi.org/10.1016/S0022-3468(99)90382-2
[15]	Devries, P.A. (2001) Posterior Sagittal Anorectoplasty. Journal of Pediatric Surgery, 17, 638-643.
[16]	Bischoff, A., Levitt, M.A. and Peña, A. (2009) Bowel Management for the Treatment of Pediatric Fecal Incontinence. Pediatric Surgery International, 25, 1027-1042. http://dx.doi.org/10.1007/s00383-009-2502-z
[17]	Har, A.F., Rescorla, F.J. and Croffie, J.M. (2013) Quality of Life in Pediatric Patients with Unremitting Constipation Pre and Post Malone Antegrade Continence Enema (MACE) Procedure. Journal of Pediatric Surgery, 48, 1733-1737. http://dx.doi.org/10.1016/j.jpedsurg.2013.01.045
[18]	Brain, A.J. and Kiely, E.M. (2001) Posterior Sagittal Anorectoplasty for Reoperation in Children with Anorectal Malformations. British Journal of Surgery, 76, 57-59.
[19]	Hassink, E.A., Rieu, P.N., Hamel, B.C., Severijnen, R.S., vd Staak, F.H. and Festen, C. (1996) Additional Congenital Defects in Anorectal Malformations. European Journal of Pediatrics, 155, 477-482.
[20]	Cho, S., Moore, S.P. and Fangman, T. (2001) One Hundred Three Consecutive Patients with Anorectal Malformations and Their Associated Anomalies. Archives of Pediatrics and Adolescent Medicine, 155, 587-591. http://dx.doi.org/10.1001/archpedi.155.5.587
[21]	Peña, A. (1995) Anorectal Malformations. Seminars in Pediatric Surgery, 4, 35-47.
[22]	Nah, S.A., Ong, C.C., Lakshmi, N.K., Yap, T.L., Jacobsen, A.S. and Low, Y. (2012) Anomalies Associated with Anorectal Malformations according to the Krickenbeck Anatomic Classification. Journal of Pediatric Surgery, 47, 2273-2278. http://dx.doi.org/10.1016/j.jpedsurg.2012.09.017
[23]	Hamid, C.H., Holland, A.J. and Martin, H.C. (2007) Long-Term Outcome of Anorectal Malformations: The Patient Perspective. Pediatric Surgery International, 23, 97-102. http://dx.doi.org/10.1007/s00383-006-1841-2
[24]	Stoll, C., Alembik, Y., Dott, B. and Roth, M.P. (2007) Associated Malformations in Patients with Anorectal Anomalies. European Journal of Medical Genetics, 50, 281-290. http://dx.doi.org/10.1016/j.ejmg.2007.04.002
[25]	Rintala, R.J. (1996) Anorectal Malformations—Management and Outcome. Seminars in Fetal & Neonatal, 1, 219-230.
[26]	Peña, A. (2001) Posterior Sagittal Anorectoplasty as a Secondary Operation for the Treatment of Fecal Incontinence. Journal of Pediatric Surgery, 18, 762-773.
[27]	Dewan, P.A., Hrabovszky, Z. and Mathew, M. (2000) Redo Anorectoplasty in the Management of Anorectal Anomaly Patients. Australian and New Zealand Journal of Surgery, 70, A109.
[28]	Van den Hondel, D., Sloots, C., Meeussen, C. and Wijnen, R. (2014) To Split or Not to Split: Colostomy Complications for Anorectal Malformations or Hirschsprung Disease: A Single Center Experience and a Systematic Review of the Literature. European Journal of Pediatric Surgery, 24, 61-69. http://dx.doi.org/10.1055/s-0033-1351663
[29]	Kumar, A., Argawala, S., Srinivas, M., Bajpai, M., Bhatnagar, V., Gupta, D.K., Gupta, A.K. and Mitra, D.K. (2005) Anorectal Malformations and Their Impact on Survival. Indian Journal of Pediatrics, 72, 1039-1042. http://dx.doi.org/10.1007/BF02724407
[30]	Fabbro, M.A., Chiarenza, F., D’Agostino, S., Romanato, B., Scarpa, M., Fasoli, L., Iannucci, I., Pinna, V. and Musi, L. (2011) Anorectal Malformations (ARM): Quality of Life Assessed in the Functional, Urologic and Neurologic Short and Long Term Follow-Up. Pediatria Medica e Chirurgica, 33, 182-192.