Outcome of children operated for congenital anorectal malformations: A prospective single center study

Introduction: Anorectal malformations (ARM) have an incidence of 1 in 5000 live births and affect male and female almost equally. Operative correction of pediatric ARM is of potential clinical interest; however, longterm outcome of patients in respect to probable complications requires precise follow up and surveillance. The aim of our study was to assess the outcomes of children undergoing surgical correction of ARMs.Materials and Methods: In a prospective follow-up study, we wanted to assess occurrence of incontinence, constipation, soiling, abdominal distension, diarrhea, stenosis, dilated sphincter and failure to thrive (FTT) in ARM patients. In addition, management of these conditions has been discussed. Reoperations have also been reviewed. The primary outcome of the study was determination of occurrence of incontinence at follow-up visits. Secondary outcomes were occurrence of constipation, anal stenosis, soiling, abdominal distension, dilated sphincter, diarrhea and FTT at followup visits. In addition, the decision of research team on patients at followup visits was considered as secondary outcomes.Results: Two hundred and ninety patients were studied. Of the study patients, 174 (60.4%) were boys and 114 (39.6%) were girls. Mean age of boys was 4.8 ± 2.0 years and mean age of girls was 5.0 ± 2.0 years. The mean follow-up period of our patients was 39.5 ± 29.1 months. During the study follow-up period, 63 patients (21.7%) had complications. The most common complication was constipation. It was present in 21 patients (33.3%). Soiling, incontinence, dilated sphincter, FTT, stenosis, abdominal distension and diarrhea were present in 21 (33.3%), 11 (17.5%), 9 (14.3%), 6 (9.5%), 6 (9.5%), 5 (7.9%), 3 (4.8%) and 2 (3.3%) patients respectively.Conclusion: We found that the most common complications following ARM surgery are constipation, soiling, incontinence, dilated sphincter, FTT, stenosis, distension and diarrhea. The overall complication rate was 21.7%. 7.2 % and 3.1% of study population experienced constipation and incontinency respectively. In 3.1% of the study population reoperation was required. We revealed that outcome of surgical correction of ARMs is considerably good and complication rates are acceptable. Continence rate was also acceptable

Is there any correlation between duration of vomiting before pyloromyotomy and eradication of symptoms after pyloromyotomy in hypertrophic pyloric stenosis?

Introduction: Hypertrophic pyloric stenosis (HPS) is among common GI disorders in young infants, with an incidence of 1-2:1000 live births in the world. In this study, we wanted to investigate the correlation between duration of symptoms before surgery and eradication of symptoms after pyloromyotomy in HPS.Materials and methods: One hundred and twenty five (102 boys and 23 girls) patients with suspected infantile HPS were treated surgically by Ramstedt pyloromyotomy between 2004 and 2014 at pediatric surgery ward of Tabriz Children’s Hospital, Iran. The demographic features, clinical findings, diagnostic work-up and postoperative specifications of the patients were studied retrospectively.Results: We studied 125 patients with HPS. Male to female ratio was 4:1. The patients were 16 to 90 days of old and the mean age was 39±1.42 days. The range of pyloric canal length was 7.60 to 29.00 mm and the mean length was 19.54±3.42 mm. Pyloric muscle diameter was 2.70 to 9.00 mm and the mean diameter was 4.86±1.14 mm. Seventy two percent of patients had episodes of vomiting after operation. Mean time of persistence of vomiting after pyloromyotomy was 15.73±0.15 hours. Mean discharge time was 55.22±0.08 hours. Radiologic findings did not show any significant correlation with persistence of vomiting or discharge time. Conclusion: The present study revealed that duration of vomiting before surgery and continuing symptoms could not predict postoperative symptom eradication after pyloromyotomy in HPS