Sameer NaradGeetanjali Medical College and Hospital, India
Title: Clinical profile, management and post operative outcomes in patients with anorectal malformations
Background: Anorectal malformations (ARM) form a very important group of anomalies dealt by pediatric surgeons. Identification of different forms of the anomaly, planning investigation and definitive surgical procedure to attain the final goal of a continent child, remains a difficult task till date. Aim of the study was to study complete clinical profile of the ARM patient, surgical procedure and post operative outcome with special emphasis on continence.
Methods: We conducted a study at Geetanjali medical college, Udaipur, Rajasthan, India for clinical profile and management of patients with ARM with assessment of post-operative outcome. All cases of ARM operated from August 2016 to June 2021 were included in the study. All aspects of the anomaly i.e., type, age and sex distribution, associated anomalies, surgical technique used and post op complications were assessed. Evaluation of continence was done by Kelly's scoring system.
Results: The 71% patients had staged surgery with posterior sagittal ano-rectoplasty (PSARP) being the most common procedure used (71%). Immediate post op complications were nil. Incontinence was present in 29% patients. Constipation was present in 46% patients. On assessing Kelly's scoring 96% patients had satisfactory score. Postoperative continence was achieved in 70.8% and in 83.3% patients after treatment (bowel management).
Conclusions: Meticulous planning and surgical technique with sphincter identification and proper placement of anorectum are most important to achieve desired results. Kelly's scoring is important to assess post operative results and plan management for incontinence. With aggressive bowel management it is possible to achieve reasonable continence and quality of life for even those anomalies with poor prognosis.
Sameer Narad completed his post-graduation in General Surgery at the age of 28 from Geetanjali Medical College and Hospital, Udaipur, Rajasthan.