Department of Pediatric Surgery, Atal Bihari Vajpayee Institute of Medical Sciences, Dr. Ram Manohar Lohia Hospital, New Delhi, 110001, India.
Pediatr Surg Int. 2021 Apr;37(4):451-456. doi: 10.1007/s00383-020-04843-5. Epub 2021 Jan 15.
To study delayed presentation of ARMs, management and its effect on surgical and functional complications.
It is a retrospective study from March 2015 to March 2020. All the patients satisfying the criteria of delayed ARMs, i.e., presenting 7 days after birth were included. Information regarding type of ARM, mode of presentation, time of presentation, associated anomalies, management strategy, postoperative complications and functional outcome was noted. Minimum follow-up period was 6 months.
Out of 102 patients with ARM, 44 patients presented late. Among the 44 patients, 9 were males and 35 were females. Associated comorbidities observed are low birth weight (n = 9) and preterm (n = 13). Associated anomalies observed were cardiac (n = 18), renal (n = 8), other gastrointestinal (n = 5) and skeletal (n = 1). (1) Male: rectourethral fistula-2 (staged repair), anal stenosis-3 (anoplasty) and anocutaneous fistula-4 (anoplasty). (2) Female: vestibular fistula: 15 (6 primary definitive surgery + 9 staged repair), ectopic anus: 3 (staged repair), anal stenosis: 2 (anoplasty), urogenital sinus: 4 (staged repair), H-type ARM: 8 (staged repair) and persistent cloaca: 3 (staged repair). Primary repair was done in 15 patients (34%), and staged repair was done in 29 patients (65.9%). Anoplasty was done in 9 patients, ASARP (modified tsuchida's procedure) in 8 patients and PSARP in 27 patients. Postoperative complications observed were constipation (n = 21, 47.7%), fecal incontinence (n = 12, 27.27%) with perianal excoriation in 2 patients, anal stenosis (n = 3, 6.8%) and rectal mucosal prolapse (n = 2, 4.5%) CONCLUSION: Delayed presentation of ARMs is not uncommon and is more common in females. Management is almost similar to those who present early. Those who present with chronic constipation and megarectum require staged repair. Complications were more frequent with delayed presentation. Hence, every newborn should have careful examination of perineum and screened for ARM to avoid possible morbidity and mortality.
研究 ARMs 的延迟表现、治疗及其对手术和功能并发症的影响。
这是一项回顾性研究，时间范围为 2015 年 3 月至 2020 年 3 月。所有符合延迟 ARMs 标准（即出生后 7 天出现）的患者均被纳入研究。记录患者的 ARM 类型、表现方式、就诊时间、相关畸形、治疗策略、术后并发症和功能结局等信息。随访时间至少为 6 个月。
在 102 例 ARMs 患者中，有 44 例为迟发型。在这 44 例患者中，男性 9 例，女性 35 例。观察到的合并症有低出生体重（n=9）和早产（n=13）。观察到的相关畸形有心脏（n=18）、肾脏（n=8）、其他胃肠道（n=5）和骨骼（n=1）。（1）男性：直肠尿道瘘-2 例（分期修复）、肛门狭窄-3 例（肛门成形术）和肛皮瘘-4 例（肛门成形术）。（2）女性：前庭瘘-15 例（6 例一期根治术+9 例分期修复）、肛门位置异常-3 例（分期修复）、肛门狭窄-2 例（肛门成形术）、尿生殖窦-4 例（分期修复）、H 型 ARM-8 例（分期修复）和永存会阴-3 例（分期修复）。15 例患者行一期修复（34%），29 例行分期修复（65.9%）。9 例行肛门成形术，8 例行 ASARP（改良 tuchida 手术），27 例行 PSARP。观察到的术后并发症有便秘（n=21，47.7%）、粪便失禁（n=12，27.27%），2 例合并肛周皮肤破损，肛门狭窄（n=3，6.8%）和直肠黏膜脱垂（n=2，4.5%）。
ARMs 的延迟表现并不少见，且在女性中更为常见。治疗方法与早期表现的患者基本相同。那些表现为慢性便秘和巨结肠的患者需要分期修复。延迟表现的并发症更为常见。因此，每个新生儿都应仔细检查会阴部，并筛查 ARM，以避免可能的发病率和死亡率。
