Analysis of 200 cases with Pediatric Anorectal Malformations

Aim: Anorectal malformations are a frequent pathology in the general surgery service at the National Children´s Hospital, however, in Costa Rica, there have been few publications about this topic. The objective of this work is to analyze patients that were operated between 1998 and 2008, to know in detail the treatments used and to determine what has the experience been, this is of extreme importance, according to the findings, to process suggestions to make improvements.

Methods: Clinical files were reviewed and all the patients with anorectal malformations operated between 1990 and 2008 were examined, controlled at the outpatient service of General Surgery at the National Children´s Hospital. The patients were grouped according to their type of anomaly and were examined to determine: congenital malformations, type of anorectal malformations, type of surgery, complications and results from the following tests: abdominal ultrasound, voiding cystourethrography, distal colography and its functional results, after three years of age. The patient´s data were placed in a data base under the Excel program to be able to analyze them and have a clear vision of the procedures utilized with each group and the results obtained.

Results: 200 cases operated between 1998 and 2008 were controlled; all were studied for congenital malformations and anal malformations. Different groups were found which were classified the following manner: those who had fistulas which were subdivided by the location of the opening: bladder neck (12 cases), prostatic urethra (12 cases), bulbar urethra (18 cases), vestibular (26 cases), perineum (92 cases), anal stenosis (12 cases); those who had no fistula: high (16 cases) or low (3 cases), and finally, cloacal malformations: high (2 cases), and low (7 cases). All the patients underwent surgery using the Peña 11 technique with the corresponding modifications. No patient was intervened utilizing laparoscopic technique.

Conclusion: These patients are very complex and must be analyzed as a whole since their malformations are very important in the results and morbid-mortality. In most cases good results were obtained. The important aspect is to control them for a long period of time and use the procedures necessary to allow a normal life style, which is possible.