Incidence and Outcomes of Anorectal Malformations in Neonates: A Tertiary Care Experience

Background: Anorectal malformations (ARM) are a spectrum of congenital anomalies of the distal hindgut and anorectal canal, often associated with systemic anomalies and neonatal morbidity. Their early recognition and surgical planning are crucial to maximizing survival and functional outcome. Objective: To identify the incidence, anatomical spectrum, and short-term outcomes of ARMs among newborns in a tertiary care unit. Materials and Methods: This retrospective cross-sectional study was conducted in the Department of Pediatric Surgery of a tertiary care hospital. Consecutive sampling of 180 neonates with ARM in the initial 28 days of life was performed. Medical records were used to retrieve demographic data on mode of delivery, type of ARM, associated anomalies, surgical management, postoperative complications, hospital stay, and survival. The statistical analysis was conducted with SPSS 26.0; Chi-square, independent t-test, and Mann-Whitney U test were used with significance at p < 0.05. Results: Of 180 neonates, 110 (61.1%) were male (p = 0.023). Most prevalent were high-type ARMs, 80 (44.5%), intermediate, 42 (23.3%), and low ARMs, 58 (32.2%) (p = 0.001). There were related anomalies in 72 (40%), mostly cardiac, 28 (15.6%) and urogenital, 22 (12.2%) (p = 0.006). Primary surgery was initial colostomy, 122 (67.8%), and posterior sagittal anorectoplasty (PSARP) 58 (32.2%) (p = 0.001). The surgical site infection was 23 (12.7%) (p = 0.042). Conclusion: High-type ARM predominated in neonates, with frequent related anomalies and acceptable short-term survival. Multidisciplinary assessment, early referral, and standardized postoperative treatment are important in achieving the best neonatal results.