Anorectal malformations:Patterns,outcome of surgical treatment and prognostic factors at Bugando medical centre,Mwanza ,Tanzania
Ramadhani Juma Mfinanga [Male]
Anorectal malformations:Patterns,outcome of surgical treatment and prognostic factors at Bugando medical centre,Mwanza ,Tanzania - Mwanza, Tanzania: Catholic University of Health and Allied Sciences [CUHAS - Bugando] : ©2017 - xi;41 Pages Includes References na Appendices
Abstract:
Background: Anorectal malformations (ARM) are common abnormalities in most parts of the world and its management remains a challenge to surgeons practicing in resource –limited setting such as Tanzania. This study determines the patterns and outcome of surgical management of ARM at a Tanzania tertiary care hospital.
Patients and Methods: This was a cross sectional study with a follow up component data from established Paediatric Surgery database that was collected prospectively from May to April 20177.
Results: A total of 109 patients (M: F ratio= 1: 1.4) were studied. The median age at diagnosis was 50 days (range= 1 day and 4 years). The majority of patients, 78(71.6%) were less than a year old. Most of patients, 91(83.5%) had major clinical type of ARMs Associated congenital anomalies were recorded in 18 (16.5%) patients. The majority of patients, 64(58.7%) reported to hospital late in acute intestinal obstruction. Most of patients in study, 107(98.2%) were initially managed by a preliminary colostomy before definitive treatment. Out of 109 patients with ARMs, only 39 (33.0%) underwent definitive operations. Of the 107 patients who had preliminary colostomy, only 28(26.2%) had their colostomies closed at the end of study period. The overall complication and mortality rates were 47.7% and 16.0% respectively. Delayed presentation (> 48 hours), associated congenital anomalies, prolonged duration of operation (> 3 hours) and surgical site infections were the main predictors of mortality (p<0.001). The follow up of patients in this study was generally good as only 3(8.3%) patients were lost to follow up. Good results using Kelly’s scoring system were obtained in 83.3% of surviving patients.
Conclusion: Anorectal malformations are common in our setting. The major type of ARMs is commoner than the minor type. The outcome of surgery is good when the patients present early at birth. Therefore there is need for increasing community awareness and among all healthcare workers who handle neonates to effect early presentation and therefore prompt management.
Wurzburg Road 35, BMC Premises, Post Code: 33102: P. O Box 1464, Mwanza – Tanzania: Phone: +255 28 298 3384: Fax: +255 28 298 3386: Email: vc@bugando.ac.tz : www.bugando.ac.tz
--Surgery
Anorectal malformations:Patterns,outcome of surgical treatment and prognostic factors at Bugando medical centre,Mwanza ,Tanzania - Mwanza, Tanzania: Catholic University of Health and Allied Sciences [CUHAS - Bugando] : ©2017 - xi;41 Pages Includes References na Appendices
Abstract:
Background: Anorectal malformations (ARM) are common abnormalities in most parts of the world and its management remains a challenge to surgeons practicing in resource –limited setting such as Tanzania. This study determines the patterns and outcome of surgical management of ARM at a Tanzania tertiary care hospital.
Patients and Methods: This was a cross sectional study with a follow up component data from established Paediatric Surgery database that was collected prospectively from May to April 20177.
Results: A total of 109 patients (M: F ratio= 1: 1.4) were studied. The median age at diagnosis was 50 days (range= 1 day and 4 years). The majority of patients, 78(71.6%) were less than a year old. Most of patients, 91(83.5%) had major clinical type of ARMs Associated congenital anomalies were recorded in 18 (16.5%) patients. The majority of patients, 64(58.7%) reported to hospital late in acute intestinal obstruction. Most of patients in study, 107(98.2%) were initially managed by a preliminary colostomy before definitive treatment. Out of 109 patients with ARMs, only 39 (33.0%) underwent definitive operations. Of the 107 patients who had preliminary colostomy, only 28(26.2%) had their colostomies closed at the end of study period. The overall complication and mortality rates were 47.7% and 16.0% respectively. Delayed presentation (> 48 hours), associated congenital anomalies, prolonged duration of operation (> 3 hours) and surgical site infections were the main predictors of mortality (p<0.001). The follow up of patients in this study was generally good as only 3(8.3%) patients were lost to follow up. Good results using Kelly’s scoring system were obtained in 83.3% of surviving patients.
Conclusion: Anorectal malformations are common in our setting. The major type of ARMs is commoner than the minor type. The outcome of surgery is good when the patients present early at birth. Therefore there is need for increasing community awareness and among all healthcare workers who handle neonates to effect early presentation and therefore prompt management.
Wurzburg Road 35, BMC Premises, Post Code: 33102: P. O Box 1464, Mwanza – Tanzania: Phone: +255 28 298 3384: Fax: +255 28 298 3386: Email: vc@bugando.ac.tz : www.bugando.ac.tz
--Surgery