Ano Rectal Malformations - A study.

Shankar, M (2011) Ano Rectal Malformations - A study. Masters thesis, Madurai Medical College, Madurai.


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INTRODUCTION : Ano Rectal Malformations (ARM) represents a complex group of congenital anomalies resulting from abnormal development of the hindgut, Allantois and Mullerian duct, leading to incomplete or partial Uro rectal septal malformations. ARM is a relatively common congenital cause of intestinal dysmorphology in the newborn. There are epidemiological differences in the level and extent of the abnormality. The spectrum of lesions varies from fairly minor lesions (e.g. Covered Anus) to some of the most complicated and complex abnormalities Cloaca, Exstrophy and Rectal atresia. The defect may include many systems - e.g. Curarino's Triad includes CNS and Vertebral Defects, Exstrophy includes bladder defects. These are a few of the myriad of presentations. It is one of the most complicated defects to correct and forms the back bone of Paediatric Surgery, the details of which is the aspiration of every student applying himself to this field. ARM forms a significant load on the surgical services, particularly in developing countries, not only in the emergency situation but also in terms of long-term corrective procedures. Although there have been major advances in the management of these children during the last 15 years, these patients still represent a continuing challenge as a result of the significant reconstructive problems involved, as well as the fact that a significant number suffer from faecal and urinary incontinence, as well as the possibility of inadequacies - sexual, non correctable defects, not to talk of the associated anomalies in later life. With development in the Surgical Specialities the management has improved and what was a certain disaster has now been converted to normal livelihood, and we now see patients who have married and borne children with a normal life span. In our study we have mainly stressed on the demographic profile of the disease and the bearing and inferences which we can aggregate from them, which have been well interpolated towards the end along with the appraisal of the surgical procedures. AIMS AND OBJECTIVES : To study the Epidemiology of Anorectal Malformation. • A demographic survey of the presenting cases. • Follow up of the cases and their outcome. • To study different surgical procedures to correct Anorectal Malformations with regards to it complications. • Analysis of the cases which did not do well. CONCLUSION : The outcome of treatment of ARM has improved, tremendously in the present scenario. What was previously a write off are now becoming correctable and these patients lead a normal life, enter adult hood, and bear children. This is because of improvement in the infra structure, availability of adequate health resources, improvement in techniques and investigation modalities. Further, understanding the complex anatomy of ARM and associated anomalies and early and appropriate surgical treatment, emphatically reduces the mortality and morbidity. The Posterior Sagittal Approach has improved functional outcome of treatment of high and intermediate ARM. The really bad cases are also being discerned by Ante natal Ultra Sound and eased off from the picture. Surgical procedures have become standardized and PSARP has become the state of the art procedure. Laparoscopy has become a tool which also helps in the high Supra Levator anomalies, giving equally good if not better results. Complex Cloacal anomalies are now correctable technically, which was previously not possible. Gross defects with associated anomalies, are bearing the crux of the mortality. Though ARM can be corrected the other anomalies do the patient in. Corrections are now possible at an earlier date, and the patients are fully corrected before the school going age. Technically continuity of the Gastro intestinal tract can be restored irrespective of the level of the lesion but the issue on in continence is yet to addressed. Further, Paediatric Surgery is a service field and may not offer financial overtures. Hence, the Government must announce ARM as a disability and offer the patients the assistance extended to the disabled. All said and done prevention is better than cure and ARM should be reduced if not preventable. Patient education on Nutritious food, Folic and Iron acid supplementation should be emphasized, and the Government can give concessions to the women in the Antenatal period.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Ano Rectal Malformations.
Subjects: MEDICAL > Paediatric Surgery
Depositing User: Kambaraman B
Date Deposited: 28 Jul 2017 03:36
Last Modified: 28 Jul 2017 03:54

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