Management of Anorectal Malformations: A Five-Year Experience from a Tertiary Care Center of Southern Iraq

Background: Anorectal malformations are frequently observed congenital anomalies in pediatric surgical patients, affecting the gastrointestinal tract. The purpose of this study is to examine the prevalence, demographic characteristics, types, and modes of presentation of anorectal malformations in our society. Additionally, we aim to estimate the presence of associated anomalies and postoperative complications. Methods: A retrospective study was conducted on all cases of anorectal malformations admitted to our pediatric surgery center between December 2017 and December 2022. A total of 104 patients were included in the study. The study examined information related to demographics, clinical presentation, and treatment outcomes. Results: The incidence of anorectal malformations was 1.029 per 5000 live births, with a male to female ratio of 2:1. Early presentations, occurring within the first 3 days of life, were observed in 85.5% of male patients and 37.1% of female patients. A history of prematurity was found in 14.5% of male patients and 20% of female patients. The most common type of anorectal malformation in male patients was rectourethral fistula (63.8%), while in female patients, it was rectovestibular fistula (65.7%). Associated anomalies were present in 41.3% of patients, with genitourinary anomalies being the most common (10.6%). Initial treatment included an initial colostomy and posterior sagittal anorectoplasty in 87 (83.7%) patients, while only 16.3% of patients underwent minimal anoplasty. Postoperative complications were reported in 47% of patients, with constipation being the most prevalent (45.2%), followed by incontinence (37.5%). Conclusion: Anorectal malformations are quite common in our society, with boys being affected nearly twice as often as girls. Unfortunately, the diagnosis in female patients is often delayed. Additionally, a high incidence of associated anomalies has been recorded. Constipation is the most frequently observed late complication. However, the majority of patients do experience acceptable outcomes in terms of continence.