Feasibility of Primary Repair for Anorectal Malformations in Uganda
Felix Oyania, MBChB, MMed
BACKGROUND: Most patients in Uganda undergo three separate staged operations: 1) initial colostomy formation; 2) repair of the ARM (called anoplasty), and 3) colostomy closure. Three operations result in a long treatment duration, potential complications with each procedure, delays in care, and stigmata associated with ostomies. GAP: Shortening duration of life with an ostomy to reduce the financial burden, social rejection, and improve school attendance. HYPOTHESIS: 1: That 1-stage repair, without an ostomy, is safe and effective for children with ARM in Uganda. 2: The ARM scoring guide will allow surgeons to accurately identify children who would benefit from primary anoplasty over a staged repair. 3: A significant reduction in catastrophic health care expenditure will occur due to fewer operations and hospital days and no need for ostomy supplies, and children will be more included by the community and able to attend school. METHODS: A retrospective review of 3-stage repair and a prospective partially randomized clinical trial of 1-, 2-, or 3- stage repairs examining complications associated with treatment of ARM, socioeconomic impact of ARM, morbidity of ostomies, and stigma of ARM related ostomies. RESULTS: Pending. IMPACT: By offering a 1- or 2- stage procedures for ARMs in a resource-limited setting, we expect to: reduce health care expenditure, length of treatment, length of hospital stay, frequency of hospital visits, and social rejection.