Bowel management outcomes in anorectal malformations: a comparative study between two referral centers in a high- and a low/middle-income country.

PURPOSE: To compare functional bowel outcomes between patients followed-up at two referral centers in a high-income country and a low/middle-income country after anorectal malformation repair (ARM).

METHODS

Cross-sectional study using Krickenbeck, Rintala and Baylor Continence Scale questionnaires. Patients below three years of age, with developmental delay, or incomplete questionnaires were excluded. Associated malformations, surgical notes, toilet training, treatment and toilet setting were considered. Results were analyzed according to age and type of ARM.

RESULTS

68 patients from Milan and 65 from Johannesburg were included. Johannesburg population was younger (mean age 10.7 ± 6.1 years old vs 7.1 ± 4.7, p < 0.001). Perineal fistula was the most common ARM type in Milan (32/68, 47%), whereas vestibular in Johannesburg (17/65, 26%). Age at toilet training was younger in Milan (33.4 ± 13.6 months vs 43.9 ± 36.0, p = 0.02). Laxatives were more used in Milan (27/68, 40%), while enemas in Johannesburg (24/65, 37%). Mean total scores were, respectively, 4.9 ± 1.5 and 5.2 ± 1.6 with Krickenbeck (p = 0,16), 14.8 ± 4.2 and 15.5 ± 3.8 with Rintala (p = 0.28), 15.4 ± 9.3 and 12.6 ± 7.6 with BCS (p = 0.06).

CONCLUSION

Despite different bowel management programs, outcomes appear similar. We recommend the active participation of health workers in questionnaire's compilation.