Patterns and treatment outcomes of anorectal malformations in Mbarara Regional Referral Hospital,Uganda |
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Authors: | Peter Kayima David Kitya Maria Punchak Geoffrey A Anderson Martin Situma |
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Institution: | 1. Department of Surgery, St Mary''s Hospital Lacor, Gulu University Medical School, Gulu, Uganda;2. Department of Surgery, Mbarara University of Science and Technology, Mbarara Regional Referral Hospital, Mbarara, Uganda;3. Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA;4. Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA |
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Abstract: | Background/purposeAnorectal malformation (ARM) is a common condition. Owing to scarcity of pediatric surgery services in Uganda, however, relatively little is known about this condition.MethodsThis was a retrospective review of medical records of all patients admitted to Mbarara Regional Referral Hospital (MRRH) from January 2014 to May 2016. MRRH serves 3–8 million people in southwest Uganda. We also enrolled patients prospectively from June 2016 to December 2016.Results78 patients were enrolled in the study. 63.38% had delayed diagnosis (presenting > 48?h after birth), and most of these were self-referrals from home. The most common malformation was a vestibular fistula. Associated congenital anomalies were seen in 20% of patients, and this was associated with increased mortality. These anomalies included limb, eye, ear and genitourinary anomalies as well as ventricular septal defects, patent ductus arteriosus, spina bifida and tracheoesophageal fistula. Posterior sagittal anorectoplasty (PSARP) was the definitive surgery used. It was performed in 58.97% of the patients. Median age of patients who underwent PSARP was 11?months. 73.91% of PSARP patients had their colostomies closed and 62.5% of these who were?≥ 3 years old had good continence outcomes. Overall mortality rate was 8.97%.ConclusionThe majority of patients are diagnosed late. Vestibular fistula is the overall most common type of ARM. In males, however, rectourethral fistula is the most common type. Definitive surgery at MRRH is performed late. Continence outcomes are good and comparable to other countries with more resources.Level of evidenceIII. |
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Keywords: | ARM anorectal malformation MRRH Mbarara Regional Referral Hospital PSARP posterior sagittal anorectoplasty RDS respiratory distress syndrome Anorectal malformations Early diagnosis Continence Uganda |
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