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: | Angela Riccio, Fabio Rossi, Antonio Aloi, Pierluigi Lelli Chiesa, Faisal Abdel Galil Nugud, Alessandro Calisti, Osman Taha Mohamed Osman, Diaaeldinn Y Salman, Mariagrazia Andriani, Paolo Giambelli |
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| Rok vydání: | 2020 |
| Předmět: |
Male
Posterior sagittal anorectoplasty medicine.medical_specialty anorectal malformations Referral medicine.medical_treatment lcsh:Surgery Context (language use) low-resource context Tertiary Care Centers Stoma Health care medicine Humans Digestive System Surgical Procedures Retrospective Studies child business.industry General surgery Rectum lcsh:RJ1-570 Attendance Colostomy Infant lcsh:Pediatrics lcsh:RD1-811 Plastic Surgery Procedures africa Child Preschool Pediatrics Perinatology and Child Health Original Article Female Surgery Observational study business |
| Zdroj: | African Journal of Paediatric Surgery, Vol 17, Iss 3, Pp 79-84 (2020) African Journal of Paediatric Surgery: AJPS |
| ISSN: | 0189-6725 |
| DOI: | 10.4103/ajps.ajps_16_20 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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