Long term bowel function after repair of anorectal malformations in Uganda

Area of Science:

• Pediatric Surgery
• Congenital Anomalies
• Gastrointestinal Function

Background:

• Anorectal malformations (ARMs) are common congenital anomalies requiring staged surgical repairs.
• Patients in low-resource settings often complete treatment at older ages compared to high-income countries (HICs).
• This study is the first to evaluate long-term bowel function in Ugandan ARM patients and compare outcomes with HICs.

Purpose of the Study:

• To assess long-term bowel function in children with anorectal malformations (ARMs) treated at a regional pediatric surgery unit.
• To compare bowel function outcomes with those reported in high-income countries (HICs).

Main Methods:

• Retrospective cohort study of children aged 3-12 years with ARMs who underwent repair between 2012 and 2017.
• Bowel function assessed using the fecal continence scoring system (Rintala and Lindahl, 1995).
• Patients categorized into Poor, Fair, Good, and Normal functional groups based on scores.

Main Results:

• Median follow-up was 2 years post-stoma closure.
• 65% of patients achieved Normal/Good long-term bowel function; 35% had Fair/Poor function.
• Prevalence of soiling was 49%, constipation 23%, and incontinence 39%; no significant association with demographic or clinical factors.

Conclusions:

• Children with ARMs in this cohort achieved fair long-term bowel function despite delayed definitive repair and prolonged stoma duration (median 1.8 years).
• Outcomes such as soiling, incontinence, and constipation indicate a need for improved follow-up care.
• Timely management of complications is crucial for optimizing functional outcomes in pediatric patients with ARMs.