Eur J Pediatr Surg
DOI: 10.1055/s-0039-1695789
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Multicenter Study of 342 Anorectal Malformation Patients: Age, Gender, Krickenbeck Subtypes, and Associated Anomalies

Tahmina Banu
1  Global Initiative for Children’s Surgery (GICS)
2  Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh
,
2  Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh
3  Department of Surgery, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
,
Maryam Ghavami Adel
1  Global Initiative for Children’s Surgery (GICS)
4  Department of Pediatric Surgery, Tehran University of Medical Sciences, Tehran, Iran
,
Kokila Lakhoo
1  Global Initiative for Children’s Surgery (GICS)
5  Oxford Children's Hospital and University of Oxford, Oxford, United Kingdom
,
2  Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh
,
Arni Das
2  Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh
,
Nugayer Sharmeen
2  Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh
,
Benjamin Yapo
1  Global Initiative for Children’s Surgery (GICS)
6  National Department of Health, Mt Hagen Highlands Regional Hospital, Mount Hagen, Papua New Guinea
,
Kazi Md Noor-ul Ferdous
2  Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh
7  Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh
,
Kh Ahasanul Kabir
2  Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh
7  Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh
,
Mirza Kamrul Zahid
1  Global Initiative for Children’s Surgery (GICS)
2  Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh
8  Shaheed Suhrawardy Medical College and Hospital, Dhaka, Bangladesh
,
Kathryn Ford
1  Global Initiative for Children’s Surgery (GICS)
5  Oxford Children's Hospital and University of Oxford, Oxford, United Kingdom
,
Md Qumrul Ahsan
2  Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh
9  Department of Pediatric Surgery, Chattogram Ma O Shishu Hospital, Bangladesh
,
Mastura Akter
2  Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh
,
Md Afruzul Alam
2  Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh
,
Mozammel Hoque
2  Chittagong Research Institute for Children Surgery, Chittagong, Bangladesh
9  Department of Pediatric Surgery, Chattogram Ma O Shishu Hospital, Bangladesh
› Author Affiliations
Funding None.
Further Information

Publication History

21 March 2019

14 July 2019

Publication Date:
26 October 2019 (online)

Abstract

Introduction Published studies based on Krickenbeck classification of anorectal malformations (ARMs) are still insufficient to assess the global as well as regional relative incidence of different ARM subtypes, gender distribution, and associated anomalies. The primary purpose of this study was to provide an estimate of those in Global Initiative for Children's Surgery (GICS) research group.

Materials and Methods We collected ARM data prospectively for 1 year from four institutes of different geographic locations. A total of 342 patients were included in this study (195, 126, 11, and 10 from Bangladesh, Iran, Papua New Guinea, and Oxford, United Kingdom, respectively).

Results Overall male to female ratio was 1:1. The most frequent ARM subtype was perineal fistula (23.7% = 81/342). About 48.5% (166/342) patients had at least one associated anomaly. Cardiac and genitourinary systems were the most commonly affected systems, 31.6% (108/342) and 18.4% (63/342), respectively. These organ-systems were followed by anomalies of vertebral/spinal (9.9% = 34/342), musculoskeletal (4.4% = 15/342), and gastrointestinal/abdominal (3.2% = 11/342) systems. Rectovesical fistula had the highest percentage (96.4% = 27/28) of associated anomalies. About 18.1% (62/342) patients had multiple anomalies. ARMs (both isolated and with associated anomalies) occurred equally in males and females. Comparison between patients from Bangladesh and Iran showed differences in relative incidence in ARM subtypes. In addition, Iranian patient group had higher percentage of associated anomalies compared with Bangladeshi (73 vs. 35.4%).

Conclusion Our study provides important insights about ARM subtypes, gender distribution and associated anomalies based on Krickenbeck classification especially from Bangladesh and Iran.