Anorectal malformation: Audit of management in a major tertiary institution in Ghana

Background: Anorectal malformation (ARM) remains a significant challenge to the child and paediatric surgeons. Its rarity is relative in Sub-Saharan Africa, where there are few specialized centres for management. This study aimed to describe the presentations, management, and preliminary outcomes of ARM in a major specialized centre. Methods: A prospective observational study, with a two-year follow-up was conducted for children (up to 15 years) who presented with ARM at the Paediatric Surgery Unit between November 2020 and July 2021. Results: Sixty-one (61) patients (M: F = 1:0.96) were studied. 28.27 % of the ARM's were detected on day one of birth. More than two thirds of the cohort (70.5 %) was first detected by mothers. The remainder (29.5 %) were detected by health professionals. Majority, 88.2 %, presented late (>24hours). 34(55.4 %) presented in a stable state, 20(32.79 %) with acute intestinal obstruction and 4(6.56 %) with sepsis. Associated congenital anomalies were observed in 7(11.48 %) of patients. All the children had a staged procedure (colostomy, PSARP and closure of colostomy). The mean duration between colostomy creation and PSARP was 7.02 +/- 2.05 months, while the mean duration between PSARP and colostomy reversal was eight months. The complication and mortality rates after all the staged procedures were 39.3 % and 2.2 %, respectively. 5.2 % had persistent faecal soiling while 3.5 % had persistent constipation at 2 years. There were no anal strictures or rectal prolapse. Conclusion: Surgical outcomes of children with ARM are generally good, although there were late and unstable presentations to the hospital. Late identification of ARM by health professionals lead to late presentation.