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. 2024 Mar 18:47:121.
doi: 10.11604/pamj.2024.47.121.42919. eCollection 2024.

Management and outcomes of vestibular anorectal malformations in a low-income country hospital

Mahumaneng Esther Mokaila  1 , Matlou Ernest Mabitsela  2 , Nyaweleni Tshifularo  1
Affiliations

Management and outcomes of vestibular anorectal malformations in a low-income country hospital

Mahumaneng Esther Mokaila et al. Pan Afr Med J. .

Abstract

Introduction: anorectal malformations (ARM) are among the most common congenital anomalies in pediatric surgery. Early detection and management of vestibular fistulas are crucial for optimal outcomes, capitalizing on the pliability of sphincter muscles and the preservation of somatosensory integration. This study aimed to assess the incidence, clinical presentation, and management outcomes of vestibular fistula ARM in a low-income hospital setting.

Methods: a retrospective audit was conducted on female pediatric patients aged up to 12 years treated for vestibular fistula ARM from January 1, 2011, to June 30, 2016. Data were collected from medical records, and patients were categorized into one of three surgical management groups. Clinical assessments, preoperative procedures, and surgical interventions were meticulously documented.

Results: among 656 neonates, the incidence of vestibular fistula ARM was 8.2%. Patients presented at various ages, with 69.4% being early presenters. Notably, 11.1% of cases presented after 30 weeks of age. Functional fistula, constipation, and bowel obstruction were common presenting symptoms. Associated anomalies were relatively low. The choice of surgical approach varied, with a predominant 3-stage at 68%. Complication development did not significantly differ between surgical groups (p-value 0.083). Immediate postoperative complications were minimal, but complications at definitive anoplasty varied among the surgical groups. Anal strictures and fistula recurrence were noted. At 12 months post-surgery, anal strictures persisted in 9 participants.

Conclusion: this study highlights the challenges and outcomes associated with vestibular fistula ARM in a resource-constrained setting. The 3-stage approach, despite its historical preference, demonstrated suboptimal outcomes. A 2-stage procedure appears to offer a balanced alternative, particularly suitable for low-income healthcare systems. Further research and collaborative efforts are essential to refine the management of vestibular fistula ARM and improve patient outcomes.

Keywords: Anorectal malformation; anal strictures; complications; management; vestibular fistula.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
age distribution of the children at the time of presentation
Figure 2
Figure 2
participants presenting symptoms
Figure 3
Figure 3
ages of the children at first procedure to correct malformation
Figure 4
Figure 4
staged-procedures performed
See this image and copyright information in PMC

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