scholarly journals PRIMARY PROCEDURE FOR ANORECTAL MALFORMATIONS IN CHILDREN; A SINGLE CENTER EXPERIENCE

2021 ◽  
Vol 29 (01) ◽  
pp. 21-25
Author(s):  
Tariq Waheed ◽  
Sajjad Ali ◽  
Muhammad Uzair ◽  
Inayat ur Rehman
Keyword(s):  
Hospital Stay ◽  
Anorectal Malformation ◽  
Wound Dehiscence ◽  
Anorectal Malformations ◽  
Good Alternative ◽  
Anal Stenosis ◽  
Paediatric Surgery ◽  
Female Ratio ◽  
Single Center Experience ◽  
Primary Procedure

Tariq Waheed , Sajjad Ali , Muhammad Uzair ,Inayat Ur Rehman Objective: To share our experience with outcome of primary procedure for anorectal malformation (ARM) in children. METHODOLOGY: Retrospective study included 40 patients from both sexes operated between January 2018 and January 2019 for high and intermediate ARM in the department of paediatric surgery Khyber teaching hospital Peshawar. Patients with common cloaca and associated life threatening anomalies were excluded. Demographic and clinical data was tabulated and analyzed. Cost of the procedure was recorded in Pakistani Rupees and hospital stay in days. Continence was evaluated by Kelly’s score and parents’ satisfaction graded by Likert scale. RESULTS: Male to female ratio was 1.6:1. Mean hospital stay was 5.91±1.01 days and mean cost of 22950 ± 3234 PKR. Wound dehiscence was recorded in 3 (7.5%), 2 (5.0%) patients developed surgical site infection and 11 (35.48%) patients had perianal excoriation. Adhesive obstruction and mucosal prolapse were seen in 1 (2.5%) patient each while anal stenosis in 2(5.0%) Patients. After 6 months 28 (70%) patients had formed stools while 12 (30%) had loose stools. Stool frequency was 0-1 time/day in majority i.e. 20 (50 %) patients. Continence was fair in 24 (60%) patients. Parents of 20 (50%) patients were very satisfied, 17(42.5%) satisfied only. Continence for age and sex revealed insignificant P values of 0.213 and 0.07 respectively. CONCLUSION: Primary procedure for anorectal malformations may be a good alternative to traditional three stage procedure in selected patients with intermediate and high variety of ARM. KEY WORDS: Anorectal malformation (MeSH); Abdominoperineal pull through (Non-MeSH); Kelly’s score (Non-MeSH).

scholarly journals Wound Dehiscence after Posterior Sagittal Anorectoplasty in Children with Anorectal Malformations

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Louise Tofft ◽  
Martin Salö ◽  
Einar Arnbjörnsson ◽  
Pernilla Stenström
Keyword(s):  
Congenital Malformations ◽  
Wound Dehiscence ◽  
Anorectal Malformations ◽  
Single Stage ◽  
Paediatric Surgery ◽  
Posterior Sagittal Anorectoplasty ◽  
Contributing Factors ◽  
Tertiary Centre ◽  
Low Weight ◽  
Ethical Approval

Aim of the Study. To assess the frequency of and identify contributing factors to wound dehiscence after posterior sagittal anorectoplasty (PSARP) in children born with anorectal malformations (ARM). Methods. Ethical approval was obtained (DNR 2017/191). Charts of all children with anorectal malformations (ARM) reconstructed with PSARP, limited PSARP, or PSARVUP at a tertiary centre of paediatric surgery between 2001 and 2016 were reviewed. Wound dehiscence within 30 days postoperatively was analysed regarding gender, prematurity, birth weight, type of ARM, other congenital malformations, single- or multistaged reconstruction, age and weight at reconstruction, postoperative antibiotics, and fasting. Multiple regression analysis was performed for risk factors in single-stage PSARP or limited PSARP, presented as odds ratio (OR) with 95% confidence interval (CI). Main Results. Ninety patients were included, of which 53 (59%) were males. Single-staged PSARP was performed in 40 (44%) patients and 50 (56%) had a multistaged reconstruction with a colostomy. Wound dehiscence was significantly more common among patients without a colostomy; 17 (43%) vs. 11 (22%) (p=0.043). In patients with single-stage PSARP, no single factor was identified to increase the risk for wound dehiscence: cardiac malformations (OR 3.73) (95% CI 0.78-17.88), low weight at surgery (OR 1.56) (95% CI 0.36-6.99), antibiotics < 1 day (OR 1.6) (95% CI 0.43-5.94), or short fasting 0-3 days (OR 4.44) (95% CI 0.47-42.18). Conclusions. A divided colostomy protected against wound dehiscence after PSARP. No risk factor for wound dehiscence after single-staged PSARP was identified. Further studies are needed to establish contributing factors to uncomplicated wound healing after PSARP.

SHORT TERM OUTCOME OF DIVERSION LOOP COLOSTOMY IN CHILDREN OF ANORECTAL MALFORMATION.

2021 ◽  
pp. 30-33
Author(s):  
Mohammed Musheer Ahmed ◽  
Rajpal Singh Sinsodhiya ◽  
A. P. Singh Gaharwar ◽  
Ramngaihzuala Chhangte
Keyword(s):  
Anorectal Malformation ◽  
Anorectal Malformations ◽  
Loop Colostomy ◽  
Large Sample Size ◽  
Related Factors ◽  
Term Outcome ◽  
Female Ratio ◽  
Stomal Prolapse ◽  
Perineal Operation ◽  
Male To Female

Purpose: Colostomy for patients with anorectal malformations decompresses an obstructed colon, avoids fecal contamination of the urinary tract, and protects a future perineal operation. The procedure is associated with several signicant complications. Objective: To study relation of various demographic factors, clinical features, complications and patient related factors with outcomes. Methods-All necessary data of these 50 patients were obtained from case sheets and attendants of patients admitted in SNCU, NICU and wards of department of paediatrics and surgery. All the details (demographic, patients related, surgery) of patient was lled in predesigned structured proforma. Results- More than half of babies were males (68%). The male to female ratio was 2.1:1. The mean weight at post-operative 7 days was 4.74±0.21 kgs which increased to 5.19±0.41 kgs at post-operative 1 month, 5.73±0.88 kgs at post-operative 2 months and 6.28±0.6 kgs at post op 3 months. There was signicant (p=0.001) increase in weight from post-operative 7 days to postoperative 1 month, 2 months and 3 months. Peri stomal skin excoriation was seen in 8% at post-operative 7 day, 14% at postoperative 1 month, 12% at 2 months and 4% at 3 months. Stomal prolapse was seen in 2% patients at post-operative 7 days and in 4% patients at 1 month & 2 months and became nil at 3 months post-operatively. There was signicant (p=0.001) difference in weight gain from 7 days to 3 months post-operative between groups of age <30 days (1.67±0.33 kgs) and ≥30 days (1.08±0.65 kgs). Conclusion- Minimal post-operative complications of diversion loop colostomy in children of anorectal malformation and hence we can conclude that loop colostomy is safe in patients with anorectal malformations. we recommend, a study with a large sample size and longer duration of follow up, needs to be done to have a more effective and rationale conclusion.

scholarly journals Comparative evaluation of sublay versus onlay meshplasty in incisional and ventral hernias

2017 ◽  
Vol 5 (1) ◽  
pp. 187
Author(s):  
B. D. Dhaigude ◽  
Aneesh Sugunan ◽  
S. V. Pancbhai ◽  
Merry Francis ◽  
Keyur Patel ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Operative Time ◽  
Wound Dehiscence ◽  
Good Alternative ◽  
Related Complication ◽  
Average Hospital ◽  
Medical College ◽  
Group A ◽  
Group B ◽  
Duration Of Operation

Background: Hernia derived from the Latin word, is a protrusion of a viscus or part of a viscus through an abnormal opening in the walls of its containing cavity. Objectives of present study were to evaluate sublay Vs onlay meshplasty in incisional and ventral hernia and to compare and determine duration of operation and hospital stay, post-operative complications and recurrences.Methods: The study was conducted at Dr. D. Y. Patil Medical College and Hospital, DPU University, for a period of 2 years (from July 2015 - September 2017) and is a prospective and comparative randomized type of study using 100 cases (Group A Onlay and Group B Sublay - 50 each). The study was approved by the Institute’s Ethics Committee.Results: 100 patients were operated in our study. In group B, the mean operative time [70.72±18.56], and in group A mean operative time (50.96±12.61). The duration of hospital stay was an of average 7.62±1.78 days in group B, and an average hospital stay of 8.84±1.89 in group A. Suture site infection was18%. group A (26%) and group B (12%). Seroma was seen in 5 patients, group A (8 %) and in group B (2%). Flap necrosis was 8% in group A and in 6% in group B. 10 patients had wound dehiscence, group A (14%) and group B (6%). 4 patients were reported with mesh infection (6%) in group A and (2%) in group B. Recurrence was 1% group A.Conclusions: Sublay meshplasty is good alternative to onlay meshplasty that may be applicable to all forms of ventral and incisional hernias. The mesh related complication rate and recurrence was found to be minimal.

scholarly journals OUTCOME OF SINGLE STAGE SPHINCTER SPARING SCARLESS ( 5S) PROCEDURE FOR RECTOVESTIBULAR FISTULA: A RETROSPECTIVE ANALYSIS

2020 ◽  
Vol 8 (11) ◽  
pp. 34-41
Author(s):  
Muhammad Riaz-Ul-Haq ◽  
◽  
Muhammad Kashif Chishti ◽  
Arsalan Raza Wasti ◽  
Mazhar Jam ◽  
...  
Keyword(s):  
Wide Spectrum ◽  
Case Series ◽  
Cost Effective ◽  
Anorectal Malformations ◽  
Single Stage ◽  
Anal Stenosis ◽  
Paediatric Surgery ◽  
Retrospective Case ◽  
Renal Anomalies ◽  
Vestibular Fistula

Background: Anorectal malformations (ARM) in girls comprise of a wide spectrum of disease ranging from imperforate anus to common cloaca, a complex malformation. Recto-vestibular fistula (RVF) is the commonest ARM in female patients. Many surgical procedures have been mentioned in the literature but trend is changing from staged to single stage procedure. Objectives: To evaluate post operative results of Single Stage Sphincter Sparing Scarless (5S) procedure for RVF. Methods: It is a retrospective case series of 24 patients with RVF who were admitted in the Department of Paediatric Surgery Jinnah Hospital Lahore and the Children Hospital and the Institute of Child Health Multan from October 2018 to September 2019, between 14 days and 4 years of age , underwent single stage sphincter sparing scarless procedure without any colostomy, anterior or posterior midline incision or division of sphincteric complex. Site of neo-anus was marked with the help of muscle stimulator and all surgeries were done under general anesthesia after meticulous gut preparation. Post operatively patients were kept nil per oral for 5 days to avoid wound contamination due to stool. Follow up was done for six months to evaluate outcome. Authors used a new name for single stage procedure. Results: Mean age was 160 days, operative time 78 minutes and hospital stay 6.8 days. 9 (37.5%) patients were diagnosed with some other associated congenital anomalies like congenital heart disease (CHD), renal anomalies, hemisacrum, syndactyly, talipes equino varus(TEV) and Downs syndrome. As a whole 13(24) presented with complication. 4(16.64%) patients presented with constipation, 3(12.5%) excoriation, 2(8.32%) anal stenosis, 2(8.32%) soiling, 1(4.16%) retraction of rectum and 1(4.16%) superficial wound infection. Patient with retraction was planned for re-do surgery, all others were managed conservatively. Conclusion: Single stage sphincter sparing scarless ( 5S) procedure for recto-vestibular fistula is safe, simple and cost effective technique. Patient suffering is minimum, as there is no colostomy, so no multiple surgeries. Complications are minimum and comparable to staged procedure.

scholarly journals Assessment of post-surgical functional outcome in children with anorectal malformation

2018 ◽  
Vol 5 (4) ◽  
pp. 1286 ◽  
Author(s):  
Jiwan Lal Patel ◽  
M. Amin Memon ◽  
Shipra Sharma ◽  
Jeewan Verma
Keyword(s):  
Functional Outcome ◽  
Anorectal Malformation ◽  
Bowel Movement ◽  
Surgical Techniques ◽  
Anorectal Malformations ◽  
Paediatric Surgery ◽  
Vaginal Fistula ◽  
Number Of Patients ◽  
Vestibular Fistula ◽  
Pouch Colon

Background: Anorectal malformations (ARMs) comprise a spectrum of congenital anomalies that continue to present a challenge for paediatric surgeons. Advances in modern surgical techniques and neonatal care have greatly improved survival among ARM patients over the last decades, and early mortality is now unusual in the absence of fatal associated cardiac or chromosomal defects. The aim of this study is to measure the functional outcome of ARM by most recent krickenburg classification.Methods: The present longitudinal study was conducted in Department of paediatric surgery, Dr. BRAM hospital, Raipur, Chhattisgarh during study period February 2016 to September 2017. Those patients who had completed their all stages of surgery for anorectal malformation at-least 6 months back and arriving at outpatient department of paediatric surgery were included.Results: Maximum number of patients were in age group of 3 to 5 years (77.8%) and minimum were 9 to 11 years (3.7%). A 50.6% male and 49.4% female child were included in the study. Maximum number of patients had vestibular fistula (38.27% followed by perineal fistula (24.69%), rectobulbar (18.51%) then rectovaginal (7.4%) and rectoprostatic (7.4%). Minimum patients had pouch colon (2.4%) and cloaca (1.09%). Voluntary bowel movement was present in 50% of rectoprostatic and 66.6% of rectovaginal fistula. Eighty percentage rectobulbar and 83.87% vestibular fistula had voluntary bowel movement. Cloaca and Pouch colon had no voluntary bowel movement. In recto-vaginal fistula 66.6% had soiling, of which 50% had grade 1 and 16.6% had grade 2 soiling. In recto-bulbar fistula 40% cases had soiling, out of which 20% had grade1 and 20% had grade 2. In recto-vaginal fistula cases 33 % had constipation, of which 16.5% had grade 1 and 16.6 % had grade 2. In recto-prostatic fistula 16% had constipation which was grade1.Conclusions: In this study, author showed that functional outcomes comparable to matched peers are achieved in the majority of low ARMs after minimally invasive, individualized perineal procedures and regular surgical follow-up. In high type of ARM soiling is the prominent feature while in intermediate ARM constipation is more common.

scholarly journals The early outcome of primary anterior sagittal approach for low anorectal malformations in female patients

2020 ◽  
Vol 36 (3) ◽  
Author(s):  
Naima Zamir ◽  
Naima Rasool
Keyword(s):  
Hospital Stay ◽  
Anorectal Malformations ◽  
Anal Stenosis ◽  
Perineal Fistula ◽  
Early Outcome ◽  
Female Patients ◽  
Surgery Outcome ◽  
Primary Surgery ◽  
Operative Complications ◽  
Post Operative Complications

Objective: To document our experience of the primary anterior sagittal anorectoplasty (ASARP) in female patients with lower and wide fistula in term of the early post operative outcome. Methods: A retrospective descriptive study was conducted in one surgical unit of the National Institute of Child Health Karachi, from January 2010 to April 2018. The study included female patients with diagnosis of imperforate anus with wide Vestibular or Perineal fistula with minimal or no straining during defecation and no excoriation of perineum. All patients underwent primary ASARP. Data regarding the age of the patients, site of fistula, the difficulties in dissection, post operative complications, stoma and re-do ASARP needed, were documented. Wound assessment was done during hospital stay, at two weeks and then at three months after surgery. Outcome was documented in terms of complications of surgery and cosmetic appearance of perineum. Data was analyzed on SPSS version 20. Results: A total of 70 patients underwent primary surgery, 48(68.57%) females had perineal fistula while 22(31.42%) had vestibular fistula. Age ranges between three months to 276 months with median of 6±39.73 months. No major injury to the rectal or vaginal wall occurred during surgical procedure. In early post-operative period, 12(17.14%) patients had wound infection with or without various extent of disruption. A total of seven (10.11%) patients underwent stoma formation, six (8.57%) patients because of wound disruption with in a week of primary surgery and in one patient due to severe anal stenosis and retraction of anal segment within three month follow up. Median hospital stay was 5±1.52 days. In 38(54.28%) paients complete wound healing occurred with no per or post operative complications. In 25(35.71%) patients, minor complications were noted and treated accordingly and results were labelled satisfactory with acceptable perineal appearance. Conclusion: The single stage procedure can be a good choice for both vestibular and perineal fisula. In majority of cases wound heals completely with minimal or no scaring and give good cosmetic results. doi: https://doi.org/10.12669/pjms.36.3.1503 How to cite this:Zamir N, Rasool N. The early outcome of primary anterior sagittal approach for low anorectal malformations in female patients. Pak J Med Sci. 2020;36(3):---------. doi: https://doi.org/10.12669/pjms.36.3.1503 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

scholarly journals Association of trisomy 21 with anorectal malformation: a cytogenetic study

2020 ◽  
Vol 8 (5) ◽  
pp. 1808
Author(s):  
Dewanshi Mishra ◽  
Garima Sehgal ◽  
Rakesh K. Verma ◽  
Archana Rani
Keyword(s):  
Birth Order ◽  
Anorectal Malformation ◽  
Trisomy 21 ◽  
Chromosomal Abnormalities ◽  
Cytogenetic Study ◽  
Uttar Pradesh ◽  
Anorectal Malformations ◽  
Paediatric Surgery ◽  
History Of ◽  
Medical University

Background: Anorectal malformations (ARM) are congenital malformations of digestive system resulting from the disturbed development of hindgut during embryogenesis. ARMs involve both sexes; can occur either isolated or in association with other congenital abnormalities and may be associated with chromosomal abnormalities. Association of trisomy 21 with anorectal malformation is well documented. Present study was conducted to assess prevalence of association of trisomy 21 in patients with anorectal malformation.Methods: Total 48 children with diagnosis of anorectal malformation, who were admitted in Department of Paediatric Surgery, King George’s Medical University, Lucknow, Uttar Pradesh, were selected for the study. Blood samples were collected and their cytogenetic analysis was carried out in the Cytogenetics laboratory, Department of Anatomy, KGMU-U.P, Lucknow, India.Results: Among the 48 study subjects, karyogram could be successfully obtained for 45 cases (93.75%). Numerical anomalies were observed in 8.9% cases. Trisomy 21 was found in 6.7%. The prevalence of trisomy 21 was found to more in males (4.5%) as compared to females (2.2%). Prevalence was highest in birth order 3(20%), followed by birth order 2(7.14%) and lowest in birth order 1(3.85%). Trisomy in association with ARM; was observed in children born to females aged >30 years. It was found unrelated to the history of consanguinity.Conclusions: Prevalence of association of trisomy 21 with ARM was found to be 6.7%. This coexistence emphasizes the need for a thorough investigation of patients with ARM.

scholarly journals Clinical Mortality Review of COVID-19 Patients at Sukraraj Tropical and Infectious Disease Hospital, Nepal; A Retrospective Study

2021 ◽  
Vol 6 (3) ◽  
pp. 137
Author(s):  
Anup Bastola ◽  
Sanjay Shrestha ◽  
Richa Nepal ◽  
Kijan Maharjan ◽  
Bikesh Shrestha ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Hospital Stay ◽  
Secondary Infection ◽  
Treatment Strategies ◽  
Chronic Obstructive ◽  
Female Ratio ◽  
Infectious Disease Hospital ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Disease Hospital

Coronavirus Disease 2019 (COVID-19) has challenged the health system worldwide, including the low and middle income countries like Nepal. In view of the rising number of infections and prediction of multiple waves of this disease, mortalities due to COVID-19 need to be critically analyzed so that every possible effort could be made to prevent COVID-19 related mortalities in future. Main aim of this research was to study about the mortalities due to COVID-19 at a tertiary level hospital, in Nepal. This was a retrospective, observational study that included all inpatients from Sukraraj Tropical and Infectious Disease Hospital, who were reverse transcriptase polymerase chain reaction positive for SARS-COV-2 and died during hospital stay from January 2020 till January 2021. Medical records of the patients were evaluated. Out of 860 total admissions in a year, there were 50 mortalities in the study center. Out of 50 mortalities, majority were males (76%) with male to female ratio of 3.17:1. Most were above 65 years of age (72%) and had two or more comorbidities (64%). The most common comorbidities among the patients who had died during hospital stay were hypertension (58%) followed by diabetes mellitus (50%) and chronic obstructive airway disease (24%). The median duration from the symptom onset to death was 18 days, ranged from the minimum of 2 days till maximum of 39 days. D-dimer was found to be >1 mg/L in 58% cases and ferritin was >500 ng/ml in 42% patients at presentation. A total of 42% patients had thrombocytopenia, 80% patients had lymphocytopenia and 60% had Neutrophil to Lymphocyte ratio >11.75 with the mean NLR of 18.38. Of total mortalities, 16% patients also showed microbiological evidence of secondary infection; Male gender, age more than 65 years, multiple comorbidities with lymphocytopenia, elevated Neutrophil lymphocyte ratio and elevated inflammatory markers were risk factors found in majority of mortalities in our study. These findings could be utilized for early triage and risk assessment in COVID-19 patients so that aggressive treatment strategies could be employed at the earliest to reduce mortalities due to COVID-19 in future.

Primary or Redo Posterior Sagittal Anorectoplasty without a Stoma: To Feed or Not to Feed?

2017 ◽  
Vol 29 (02) ◽  
pp. 150-152 ◽  
Author(s):  
Clare Skerrit ◽  
Alexander Dingemans ◽  
Victoria Lane ◽  
Alejandra Sanchez ◽  
Laura Weaver ◽  
...  
Keyword(s):  
Breast Milk ◽  
Wound Dehiscence ◽  
Anorectal Malformations ◽  
Wound Complication ◽  
Wound Complications ◽  
Age At Surgery ◽  
Significant Difference ◽  
Male Patients ◽  
The Mean ◽  
Picc Line

Introduction Repair of anorectal malformations (ARMs), primarily or with a reoperation, may be performed in certain circumstances without a diverting stoma. Postoperatively, the passage of bulky stool can cause wound dehiscence and anastomotic disruption. To avoid this, some surgeons keep patients NPO (nothing by mouth) for a prolonged period. Here, we report the results of a change to our routine from NPO for 7 days to clear fluids or breast milk. Materials and Methods After primary or redo ARM surgery, patients given clear liquids were compared to those who were kept strictly NPO. Age, indication for surgery, incision type, use of a peripherally inserted central catheter (PICC) line, and wound complications were recorded. Results There were 52 patients, including 15 primary and 37 redo cases. Group 1 comprised 11 female and 15 male patients. The mean age at surgery was 4.9 years (standard deviation [SD]: 2.3). There were 8 primary cases and 18 redo cases. Twelve (46.6%) received a PICC line. The average start of clear liquids was on day 5.3 (SD: 2.2) after examination of the wound, and the diet advanced as tolerated. The first stool passage was recorded on average on day 2.3 (SD: 1.3). Four minor wound complications and no major wound complications occurred.Group 2 comprised 14 females and 12 male patients. The mean age at surgery was 3.5 (SD: 2.4) years. There were 7 primary and 19 redo cases. One (3.8%) patient required a PICC line. A clear liquid diet was started within 24 hours after surgery. A regular diet was started on average on day 5.8 (SD: 1.3). The first stool passage was recorded on an average of day 1.6 (SD: 0.9). Three minor wound complications occurred; however, there was no significant difference between the two groups (SD: 0.71). One major wound complication occurred. However, there was no significant difference in major wound complications between the groups (SD: 0.33). Conclusion No increase in wound problems was noted in children receiving clear liquids or breast milk compared with the strict NPO group, and PICC line use was reduced. We believe this change in practice simplifies postoperative care without increasing the risk of wound complications.

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