OUTCOMES OF POSTERIOR SAGITTAL ANORECTOPLASTY FOR HIGH ANORECTAL MALFORMATION IN BENIN CITY, NIGERIA

Area of Science:

• Pediatric Surgery
• Congenital Malformations
• Gastrointestinal Surgery

Background:

• Surgical management of high anorectal malformations has evolved, with posterior sagittal anorectoplasty (PSARP) becoming a standard procedure.
• A review of PSARP outcomes in Benin City, Nigeria, is necessary given its widespread use.

Purpose of the Study:

• To evaluate the 10-year outcomes and surgical experience with PSARP in children diagnosed with high anorectal malformation.
• To assess the efficacy and complications of PSARP in a Nigerian tertiary hospital setting.

Main Methods:

• Retrospective analysis of pediatric patients with high anorectal malformation treated with PSARP.
• Data collected from April 2006 to March 2016 at the University of Benin Teaching Hospital.
• Inclusion criteria: high anorectal malformation managed with PSARP.

Main Results:

• 33 (34.4%) of 96 anorectal malformation cases were high-type, predominantly in males (1.3:1 ratio).
• Most high-type cases (94%) had recto-bladder neck/prostatic or recto-vaginal fistulae.
• PSARP without colostomy was tolerated in 15% of neonates; 85% had conventional PSARP with initial colostomy. Postoperative morbidities (30.3%) included wound infection, anal stenosis, and fecal incontinence. Majority (54.5%) achieved continence; 12.1% had voluntary bowel control. One death (3%) occurred due to colostomy closure breakdown in a child with prune belly syndrome.

Conclusions:

• Anorectal malformation is common in this Nigerian setting, with a significant proportion of high-type cases.
• Posterior sagittal anorectoplasty demonstrated good functional outcomes and manageable complications in this cohort.
• PSARP is a viable surgical option for high anorectal malformations in resource-limited settings.