Functional Outcomes of Anorectal malformation: A 5 years Retrospective Study at single institution, Ethiopia.
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Date
2025
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Addis Ababa Uinverstiy
Abstract
Anorectal malformation (ARM) is a wide spectrum of congenital
malformation seen in pediatric patients. While the surgical techniques have advanced
long term functional outcomes like voluntary bowel movement, soiling and
constipations remain significant challenge for clinicians and patients especially in low
income countries like Ethiopia. Objectives: To assess the functional outcomes of surgically reconstructed anorectal
malformations and identifying factors affecting the outcomes at single tertiary
institution in Ethiopia. Methodology: This is a retrospective cohort study which was conducted on 119
children treated for ARM over a 5-year period from September 2018 to September
2022. Functional outcomes was assessed using the Krickenbeck classification systems. Bivariate analysis was performed by using Chi-square, Fisher’s exact tests and Mann- Whitney U tests where they were appropriate according to the types of variables, then
followed by multivariable logistic regression to identify independent affecting factors
with Adjusted Odds Ratios [AOR] and 95% Confidence Intervals [CI]. Results: 84.9% of patients achieved VBM, while soiling and constipation were 47.1%
and 24.4%, respectively. High ARM types were associated with higher soiling rates
(77.8%; AOR 0.133, 95% CI: 0.031- 0.564, p=0.006). Conversely, low ARM type
was associated with constipation (43.5%; AOR 8.4, 95% CI: 1.48-47.66, p=0.016). Redo anoplasty was associated with poor VBM (AOR 0.1, 95% CI: 0.02-0.49, p=0.005) and increased soiling (AOR 0.128, 95% CI: 0.028-0.582, p=0.008). While
three-stage repairs showed higher soiling in bivariate analysis, multivariable analysis
showed no independent effect. Early age at definitive surgery was associated with
better voluntary bowel movement (AOR 0.97, 95% CI: 0.93-0.99, p=0.024). Conclusion and Recommendation: A functional outcome of ARM patients after
surgical reconstruction at TASH is comparable to international studies. Types of
ARM, redo anoplasty and age at definitive surgery were identified as independent
affecting factors of the functional outcomes. However; neither stages of the surgery
nor birth weight was independent affecting factor. So, the high rate of soiling need
structured postoperative bowel management and follow-up. Early definitive surgery
and decreasing of technical failures requiring reoperation are required for improving
functional outcomes.
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Keywords
Anorectal Malformations, Voluntary Bowel Movement, Soiling, Constipation, Redo Anoplasty, Functional Outcomes, Ethiopia, Pediatric Surgery