Outcome of primary posterior sagittal anorectoplasty of high anorectal malformation in well selected neonates

Background: Conventional posterior sagittal anorectoplasty (PSARP) for high anorectal malformation (ARM) involves initial colostomy creation with its attendant complications, but primary PSARP in neonates requires no initial colostomy. Objectives: To report on locally adapted inclusion criteria and outcomes of primary PSARP in neonates in Benin City. Materials and Methods: Babies who presented during the first week of life in clinically stable conditions, without cardiac anomaly, and had hemogram and blood chemistry within normal ranges, were included in this prospective study undertaken at the University of Benin Teaching Hospital in 2008-2011. Results: Fifty children with ARM comprising 19 (38%) low/intermediate and 31 (62%) high anomalies were treated during the period. Five (10%) singletons delivered via spontaneous vaginal delivery at term. Aged at operation between two and seven (mean 4) days and comprised three males and two females (ratio 1.5: 1), met the inclusion criteria for primary PSARP. The procedure was well tolerated by all the babies; oral intake was commenced on the second post-operative day with nine days median hospitalization duration. No mortality was recorded on six months to four years follow-up. Apart from minor superficial perianal surgical site infection in one baby which responded to antibiotics, no post-operative sepsis or breakdown of repair was recorded. Continence and other anal functions were found excellent using the modified Wingspread scoring during follow-up. Conclusion: These outcomes showed that with meticulous selection, primary PSARP in neonates was feasible and safe in a developing country. Multicenter studies and long-term follow-up are advocated World-wide.