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Evaluation and management of "low" anorectal malformation in male children: an observational study
Gaurav Shandilya1, Anand Pandey2, Nitin Pant1
1Department of Pediatric Surgery, King George's Medical University, Lucknow, UP, 226003, India.
Insights
Low Anorectal Malformation (ARM) with a perineal fistula in males presents diversely. Early assessment and expert management are crucial for better outcomes and fewer complications.
Area of Science:
- Pediatric Surgery
- Colorectal Surgery
- Congenital Anomalies
Background:
- Low Anorectal Malformation (LARM) with a perineal fistula is a common anorectal malformation.
- Traditionally, LARM has been defined by the presence of a perineal fistula.
Purpose of the Study:
- To evaluate Low Anorectal Malformation (LARM) in male patients.
- To identify factors influencing the outcome and follow-up of LARM in males.
Main Methods:
- Retrospective cohort study of 301 male patients over 8 years.
- Assessment of clinical presentation, associated anomalies, and complications.
- Surgical procedures included cutback anoplasty; patients were followed in outpatient departments.
Main Results:
- Most patients (n=214) presented neonatally with absent/abnormal anal opening, abdominal distension, constipation, or peritonitis.
- Perineal fistula was the most common presentation; urologic anomalies were most frequent associated anomalies.
- Constipation was the most common follow-up complication; 14 patients were referred after complications.
Conclusions:
- Male LARM exhibits diverse presentations requiring thorough assessment of associated anomalies.
- Awareness and expert management can prevent delayed presentation and complications.
- Regular follow-up is essential for effective management of LARM.
Purpose:
ARM with perineal fistula has been traditionally defined as low ARM (LARM). This study was conducted to evaluate LARM in male patients with an emphasis on the role of various factors on the outcome and follow-up of them.
Materials And Methods:
It was a retrospective cohort study. The clinical presentation, associated anomalies, and complications were assessed. The operative procedures included cutback anoplasty and others. The patients were followed in the outpatient department. The complications were assessed and managed accordingly.
Results:
During the study period of 8 years, 301 patients were admitted. The complaints included absent or abnormal anal opening, abdominal distension, constipation, and peritonitis. Most of the children (n = 214) presented in the neonatal period. The most common clinical presentation was the perineal fistula. The most common associated anomaly was urologic. Fourteen patients were referred from other centers after complications. The most common problem in follow-up was constipation.
Conclusion:
LARM in male patients may have a diverse presentation. The associated anomalies need proper assessment. Awareness may avoid delayed presentation and unwanted complications. When managed by an expert, the condition can be effectively managed. Regular follow-up is important.
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