Nasirul Hasan Khawaja, Khalilur Rehman, Asmaa Qureshi.
High anorectal malformations: surgical repair in neonatal age is better than delayed repair.
Pak J Med Res Jan ;45(1):10-3.

Background: The malformations of the anorectum are common congenital anomalies. The usual treatment of high anorectal malformations is creating a colostomy at birth, posterior sagittal anorectoplasty (PSARP) at 9-12 months of age and closure of colostomy 4 - 6 weeks later after regular anal dilatation. This `delayed PSARP` has a number of disadvantages including poor development of normal defecation reflexes. Aims: To evaluate continence, cost of management and duration of hospitalization with primary PSARP and to compare it with delayed PSARP. Setting: This prospective study was done at the Department of Pediatric Surgery, Children Hospital, Lahore from Nov 1999 to Nov 2001. Subjects & Methods: Twenty-four infants (19 boys, 05 girls) with high anorectal malformation were included in the study. All had well developed sacrum and natal cleft, and weighed more than 3 Kg. Twelve patients underwent primary PSARP (Group A) and 12 underwent colostomy, PSARP and then colostomy closure as a three stage procedure (Group B). Results: The incidence of urinary tract infections (75%), distal loop fecal impaction (41.7%) peri-colostomy skin excoriation (41.7%) was high in Group B as compared to those in Group A. The rate of post PSARP complications and hospital stay was longer in Group B and the average cost including operative procedures, hospital admissions for each complication and follow-up was high (Rs 14,670 ± 400) in Group B. Conclusions: These results suggest that one stage PSARP is a safe and viable approach to the management of high anorectal malformations in a selected group of neonates.

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