Lessons from 63 Consecutive Cases in a Developing Country Setting on the Surgical Spectrum of Anorectal Malformations (ARMs)

Haidar Mohammed Muhssein

doi:10.51699/cajmns.v7i1.3008

Haidar Mohammed Muhssein Department of Surgery (Pediatric Surgery), University of Kufa, College of Medicine, Najaf, Iraq

DOI: https://doi.org/10.51699/cajmns.v7i1.3008

Keywords: Posterior Sagittal Anorectoplasty, Anorectal Malformation, Imperforate Anus, Pediatric Surgical Treatment, Developing International Locations, Iraq

Abstract

A vast variety of congenital abnormalities of the distal anus and rectum are referred to as anorectal malformations (ARMs). Neonatal surgery has advanced, but because of delayed diagnosis and a lack of resources, the burden is still high in developing nations. The purpose of this study is to outline the range of ARM types, surgical techniques, and initial results from an Iraqi tertiary facility. All ARM patients treated at a tertiary pediatric surgery unit between January 2016 and March 2024 were retrospectively reviewed. Patient demographics, fistula type, surgical technique, and early postoperative results were among the information gathered. The Krickenbeck classification was used to categorize ARMs by sex. 39 male patients (61.9%) and 24 female patients (38.1%) made up the 63 consecutive patients that were included. The most frequent abnormality in males was rectoperineal fistula (15/39, 38.5%), which was followed by rectobulbar (12/39, 30.8%), rectoprostatic (8/39, 20.5%), imperforate anus without fistula (3/39, 7.7%), and rectobladder neck fistula (1/39, 2.5%). Rectovestibular fistula was the most common in females (12/24, 50%), followed by rectoperineal (9/24, 37.5%), cloaca (2/24, 8.3%), and imperforate anus without fistula (1/24, 4.2%). While high and intermediate lesions were repaired in stages using colostomy and posterior sagittal anorectoplasty (PSARP), the majority of low lesions were treated with perineal anoplasty. Eleven patients (17.5%) experienced early postoperative complications, mainly mild anal stenosis and wound infection. There was no perioperative death. The prevalence of low and intermediate ARMs in Iraqi children is highlighted in this study, which also emphasizes how crucial early diagnosis, referral, and suitable staging are to positive results. Increasing the capacity of neonatal surgical services in developing nations is still essential to achieving better long-term outcomes.

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