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ORIGINAL ARTICLE
Year : 2020  |  Volume : 17  |  Issue : 3  |  Page : 79-84

Challenges, constraints and failures that are related to the posterior sagittal anorectoplasty approach to anorectal malformations in a low-resource context: An experience from a sudanese tertiary referral centre


1 Department of Aging Science, Pediatric Surgery Unit, Civil Hospital 'Santo Spirito' of Pescara, University 'G. d'Annunzio' of Chieti-Pescara, Pescara, Italy
2 Ada Manes Foundation for Children, Pescara, Italy
3 Italian Agency for Development Cooperation, Khartoum, Sudan
4 Gezira National Center of Pediatric Surgery, University of Gezira, Wad Medani, Sudan
5 Department of Mother and Child Health, Pediatric Surgery Unit - Hospital 'Maggiore Della Carità', Novara, Italy
6 Department of Mother and Child Health, Pediatric Surgery Unit – San Camillo Forlanini Hospital, Rome, Italy

Correspondence Address:
Prof. Alessandro Calisti
Via Euclide Turba 4 - 00195, Rome
Italy
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ajps.AJPS_16_20

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Background: Anorectal malformations (ARMs) in the sub-Saharan Africa are a common cause of neonatal referral for intestinal obstruction, and the posterior sagittal anorectoplasty (PSARP) approach is rapidly spreading. The small number of paediatric surgeons and the low-resource context limit children's access to care and constrain the quality of results. A retrospective, observational study has been done on a consecutive series of ARM cases admitted to a Sudanese tertiary paediatric surgical centre within the framework of a partnership between Italian and Sudanese academic institutions addressed to review and upgrade the standard of care of major congenital anomalies. Materials and Methods: The authors collected 94 ARM cases in a 3 years' period. Conditions on referral, operative procedures, post-operative course and follow-up were recorded and examined. Their correlations with complications and outcome were analysed. Results: The male/female ratio was 47/47. Eighty patients presented with an untreated ARM; 66 had a divided stoma and 14 had already a PSARP procedure, followed by a poor outcome or sequelae. In 25% of the cases, colostomy required re-doing. In 57 cases, a staged PSARP (primary or re-do) was done. Surgical-site infections occurred in nine patients. Some patients were lost to follow-up after preliminary colostomy. Post-operative dilatation programme suffered from the lack of systematic follow-up, and colostomy closure was possible in 46% of the cases due to problems in travelling and accessing hospital care. Anal stenosis was frequently observed among unfollowed patients. Conclusion: Despite PSARP's widespread adoption in Africa, the risk of complications and failures is high. Primary management is often inappropriate, and a high rate of colostomy-related complications is observed. Poverty and lack of transportation reduce attendance to follow-up, hampering the final results. Investments in healthcare facilities and retention of trained health providers are needed to improve the standard of care.


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