Department of Paediatric Surgery, Sefako Makgatho Health Sciences University, Pretoria, Gauteng, South Africa.
Department of General Surgery, Sefako Makgatho Health Sciences University, Pretoria, Gauteng, South Africa.
Pan Afr Med J. 2024 Mar 18;47:121. doi: 10.11604/pamj.2024.47.121.42919. eCollection 2024.
anorectal malformations (ARM) are among the most common congenital anomalies in pediatric surgery. Early detection and management of vestibular fistulas are crucial for optimal outcomes, capitalizing on the pliability of sphincter muscles and the preservation of somatosensory integration. This study aimed to assess the incidence, clinical presentation, and management outcomes of vestibular fistula ARM in a low-income hospital setting.
a retrospective audit was conducted on female pediatric patients aged up to 12 years treated for vestibular fistula ARM from January 1, 2011, to June 30, 2016. Data were collected from medical records, and patients were categorized into one of three surgical management groups. Clinical assessments, preoperative procedures, and surgical interventions were meticulously documented.
among 656 neonates, the incidence of vestibular fistula ARM was 8.2%. Patients presented at various ages, with 69.4% being early presenters. Notably, 11.1% of cases presented after 30 weeks of age. Functional fistula, constipation, and bowel obstruction were common presenting symptoms. Associated anomalies were relatively low. The choice of surgical approach varied, with a predominant 3-stage at 68%. Complication development did not significantly differ between surgical groups (p-value 0.083). Immediate postoperative complications were minimal, but complications at definitive anoplasty varied among the surgical groups. Anal strictures and fistula recurrence were noted. At 12 months post-surgery, anal strictures persisted in 9 participants.
this study highlights the challenges and outcomes associated with vestibular fistula ARM in a resource-constrained setting. The 3-stage approach, despite its historical preference, demonstrated suboptimal outcomes. A 2-stage procedure appears to offer a balanced alternative, particularly suitable for low-income healthcare systems. Further research and collaborative efforts are essential to refine the management of vestibular fistula ARM and improve patient outcomes.
肛门直肠畸形（ARM）是小儿外科中最常见的先天性畸形之一。早期发现和管理前庭瘘对于获得最佳结果至关重要，这可以利用括约肌的柔韧性和感觉整合的保留。本研究旨在评估低收入医院环境中前庭瘘 ARM 的发生率、临床表现和管理结果。
对 2011 年 1 月 1 日至 2016 年 6 月 30 日期间接受前庭瘘 ARM 治疗的 12 岁以下女性儿科患者进行回顾性审核。数据从病历中收集，患者分为三组手术管理组之一。详细记录临床评估、术前程序和手术干预措施。
在 656 名新生儿中，前庭瘘 ARM 的发病率为 8.2%。患者在不同年龄段出现，其中 69.4%为早期出现。值得注意的是，有 11.1%的病例在 30 周后出现。功能性瘘管、便秘和肠梗阻是常见的首发症状。相关畸形相对较低。手术方法的选择多种多样，以 68%的 3 期手术为主。手术组之间的并发症发展没有显著差异（p 值 0.083）。术后即刻并发症很少，但在确定性肛门成形术的手术组中存在差异。出现肛门狭窄和瘘管复发。术后 12 个月，9 名参与者仍存在肛门狭窄。
本研究强调了资源受限环境中前庭瘘 ARM 相关的挑战和结果。尽管历史上偏好 3 期手术，但结果并不理想。2 期手术似乎提供了一种平衡的替代方案，特别适合低收入医疗保健系统。进一步的研究和合作努力对于完善前庭瘘 ARM 的管理和改善患者结局至关重要。
