Patients with Anorectal malformations managed at a paediatric colorectal clinic in South Africa and requiring transition to adult care

Abstract Background: Anorectal malformations (ARMs) are congenital defects requiring lifelong management, including surgeries and bowel management strategies. Transitioning from pediatric to adult care presents challenges, especially in low- and middle-income countries (LMICs) like South Africa, where fragmented healthcare systems complicate the process. This study examines the management of ARM patients transitioning to adult care at a Paediatric Colorectal Clinic in South Africa, emphasizing the need for structured transition programs. Methods: We reviewed the demographics, anatomical anomalies, surgical interventions, and outcomes of patients aged 9 years and older at the Johannesburg Paediatric Colorectal Clinic. Data was extracted from patient files and the clinic's database. Seventy patients met the inclusion criteria, and descriptive statistics were used for analysis. Results: Of 277 ARM patients, 70 (25%) met the inclusion criteria. The majority were male (64%), with a median age of 13 years (range: 10 to 32). Common malformations included recto-vestibular fistula (15.7%) and cloaca (12.9%). A total of 315 procedures were performed, with a mean of 4.5 operations per patient. Functional outcomes showed 89% achieved voluntary bowel control; however, 64% of patients aged 16 or older required antegrade continence enema. Forty percent of these patients needed ongoing nephrology and urology care. Conclusion: The findings highlight the complexity of ARM management, underscoring the need for a structured transition program to ensure continuity of care. Such programs are vital in low- and middle-income countries to improve long-term outcomes and quality of life for patients.