Abstract:

Background: Congenital anterior abdominal wall defects (CAAWDs) are common, their management remain a challenge to surgeons practicing in resource-limited setting. There is paucity of information regarding CAAWDs in Tanzania and Bugando Medical Centre (BMC). This study aimed to describe the clinical patterns and short term treatment outcomes of CAAWDs at BMC.

Methods: This was a longitudinal prospective study of patients with CAAWDs managed at BMC between September – 2021 and February – 2022. Ethical approval to conduct the study was obtained. Data was collected using a structured, coded and pretested questionnaire and analyzed using STATA version 15.

Results: A total of130patients were studied. The median age at diagnosis was 13.5months, there was slight male predominance M: F 1.1: 1. Majority of patients, 65(50.0%) were aged ≤12months old. Associated anomalies were reported in 30.4% and 38.5% of cases of omphalocele and gastroschisis respectively. None of the patients had a prenatal diagnosis. More than half of patients 75(57.7%) were treated surgically. Complication rate was 40.8% and sepsis was the most frequent complication in 43% of cases. Prematurity(p=0.002), low birth weight(p<0.001), gastroschisis(p<0.001), ASA III(p=0.005), treatment modality(p<0.001) and presence of associated anomalies(p=0.034) were significantly associated with complications. The median length of hospital stay was 15 days and was significantly longer in patients with omphalocele(p<0.001), associated anomalies(p=0.001), ASA class III(p=0.032) and in patients who were treated non-surgically(p<0.001). The overall mortality rate in this study was 30.0% and it was significantly associated with prematurity(p<0.001), low birth weight(p<0.001), home delivery(p=0.025), gastroschisis(p<0.001), treatment modality(p<0.001), presence of associated anomalies(p<0.001) and ASA class III(p=0.027).

Conclusion: CAAWDs are common in our setting. Many patients presented late with complications that resulted in poor outcome. The outcome of non-operative treatment is poor as majority present late in poor general condition. Therefore, there is a need for increasing awareness to effect early presentation and management.