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.

Autor: Chiesa PL; Department of Aging Science, Pediatric Surgery Unit, Civil Hospital 'Santo Spirito' of Pescara, University 'G. d'Annunzio' of Chieti-Pescara, Pescara, Italy., Aloi A; Department of Aging Science, Pediatric Surgery Unit, Civil Hospital 'Santo Spirito' of Pescara, University 'G. d'Annunzio' of Chieti-Pescara, Pescara, Italy., Andriani M; Ada Manes Foundation for Children, Pescara, Italy., Giambelli P; Italian Agency for Development Cooperation, Khartoum, Sudan., Nugud FA; Gezira National Center of Pediatric Surgery, University of Gezira, Wad Medani, Sudan., Osman OTM; Gezira National Center of Pediatric Surgery, University of Gezira, Wad Medani, Sudan., Riccio A; Department of Aging Science, Pediatric Surgery Unit, Civil Hospital 'Santo Spirito' of Pescara, University 'G. d'Annunzio' of Chieti-Pescara, Pescara, Italy., Rossi F; Department of Mother and Child Health, Pediatric Surgery Unit - Hospital 'Maggiore Della Carità', Novara, Italy., Salman DY; Gezira National Center of Pediatric Surgery, University of Gezira, Wad Medani, Sudan., Calisti A; Department of Mother and Child Health, Pediatric Surgery Unit - San Camillo Forlanini Hospital, Rome, Italy.
Jazyk: angličtina
Zdroj: African journal of paediatric surgery : AJPS [Afr J Paediatr Surg] 2020 Jul-Dec; Vol. 17 (3 & 4), pp. 79-84.
DOI: 10.4103/ajps.AJPS_16_20
Abstrakt: 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.
Competing Interests: None
Databáze: MEDLINE
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