15-year clinical experience over the patients with anorectal malformation

ABSTRACT 15-YEAR CLINICAL EXPERIENCE OVER THE PATIENTS WITH ANORECTAL MALFORMATION In this study, the clinical information about 96 patients who were operated, treated and followed with the diagnosis of ARM betwee 1996 and 2011 in Fırat University Hospital Pediatric Surgery Clinic was analyzed retrospectively. The information about the cases obtained by analyzing epicrisis, the hospital records of the patients, when they were brought to the hospital, their weight, gestation age, birth place, delivery time and method, clinical findings, atresia types, additional anomaly situations, type of surgery, early and late surgery complications, existing clinical complaints, the reasons of morbidity and mortality were investigated. In the survey prepared, their anectoral functions (controlled bowel movement, soiling ,constipation) were analyzed. Whether there are any differences among the results of atresia types due to SPSS statistics program was analyzed by using Chi-square test. Among 96 patients diagnosed with anorectal malformation, 67 patients were male and 29 patients were female. 45 patients had low type ARM, 10 had intermediate type ARM and 41 had high type ARM. While 22 patients brought to our clinic did not have any fistula, 74 patients had fistula. 4 of these fistulas were anovestibular, 32 were perineal, 14 were rectourethral, 4 were rectovaginal, 14 were rectovestibular and 6 were rectovesical. Out of 53 patients who had colostomy, sigmoid to 42 cases, transversloop to 4 cases, rectovestibular to 14 cases, ostomigastrostomy to 4 cases, Hartman to 2 cases and gastrostomy to 1 case were operated. 58 out of 78 patients had controlled bowel movement. 23 patients had soiling but 55 did not have it. 37 patients had constipation while 41 did not have constipation. The mortality rate of the patients with additional anomaly was high. Out of 18 patients having exitus, 2 patients died because of sepsis, 7 died because of heart failure, 3 died because of respiratory failure and 6 died because of anomaly due to urinary system. As a result, the mortality is high in patients with low birth weight, premature birth, high type ARM, additional anomaly, postop early complications. Fecal incontinence is stil the most important morbidity problem for the patients with high and intermediate type ARM. Key Words: Anorectal Malformation, Mortality, Morbidity.