A five year experience of anorectal malformation surgical reconstrunctions and functional outcome associated factors in Eastern Africa.

BACKGROUND: Functional outcomes after definitive surgical reconstruction in the management of Anorectal malformations (ARM) patients have not been adequately studied in the third-world countries. OBJECTIVE: This retrospective cross sectional analytical study aimed at evaluating the functional outcome and attributable factors following the definitive reconstruction surgery among children with ARM at Muhimbili National Hospital. METHODS: Patients with ARM who underwent definitive reconstruction surgery between 2017 and 2021 were recruited in the current study using the consecutive sampling method. The functional outcome and severity were assessed using the modified Krickenbeck scoring system.Analysis was performed using STATA version 16.0. RESULTS: 116 pediatric patients with ARM who underwent definitive surgical repair were reviewed, the mean age was 4.4 (SD1.8) years. The male-to-female ratio was 1.1:1. The functional outcome was voluntary bowel movement (VBM), constipation, and soiling with a prevalence of 63%, 22%, and 15% of patients respectively. Babies born preterm shows significant association with constipation with P- the value of 0.003, OR 13.26, and 95% CI 2.48-70.87. Abdominal perineal pull-through among patients who had High ARM showed a significant association with soiling (P-value 0.001, OR 0.03, and 95% CI of 0.01-0.16). CONCLUSION: In the current study we identified that there is no significant variation in ARM functional outcome between males and females.However some factors such as the type of surgery, patient body weight and the complexity of anorectal malformation were all decisive factors for achieving the optimum Voluntary Bowel Bovement (VBM) following ARM repair surgery.