Early results of the posterior saggital anorectoplasty in the treatment of anorectal malformations in Nigerian children

CONTEXT: The ultimate goal of reconstruction in anorectal malformations (ARM) in children, is to create a functional and anatomically aesthetic neoanus.
AIMS: To document our experience with the technique of PSARP in ARM and the immediate anatomical and functional outcome
SETTINGS AND DESIGN: A retrospective study 39 patients with high and intermediate ARM, managed by the posterior saggital approach, at the Obafemi Awolowo University Teaching Hospital in Ile Ife, Nigeria
MATERIALS AND METHODS: Patient′s bio-data were collected, as well as, the presentation, investigations, associated malformations, complications, average bowel opening per day and follow up.
RESULTS: There were 17 males and 22 females (male: female ratio 1: 1.3). Twenty-three patients (59%) and 15 patients (38.5%), had intermediate and high malformations respectively, while 1(2.5%) had cloaca malformation. The mean age at presentation was 13.9±30.1 month (range 2 day to 15 years), while the mean age at PSARP was 21.6±29.9 months (range 2.5 days to 15 years). 3(7.6%) patients required laparotomy to mobilize the rectal pouch from the abdomen. Mucosal prolapse was the most common significant postoperative problem, occurring in 4(10.3%) patients. The average bowel motion was 3 times daily (range 1 to 8 times per day).
CONCLUSIONS: The PSARP is a useful procedure for the correction of ARM, in children in developing countries, even in the absence of muscle stimulators. The immediate anatomical outcome is satisfactory, but functional results are difficult to access because of poor follow up.

Keywords
Posterior saggital anorectoplasty, anorectal malformations, Nigerian children