title: Management of anorectal malformation: Changing trend over two decades in Zaria, Nigeria.
abstract: BACKGROUND
  Anorectal malformation is a common congenital defect and its management has evolved over the years. This is a review of the trend in the management of this condition in a major paediatric surgical centre in Nigeria over two decades.
  
  
  METHODS
  A retrospective analysis of 295 patients with anorectal malformations managed from January 1988 to December 2007 was carried out.
  
  
  RESULTS
  There were 188 boys and 107 girls aged 1 day-9 years (median 8 years) at presentation. There were 73 (54.5%) and 106 (65.8%) emergency operations in groups A and B, respectively. There were 61 (45.5%) and 55 (34.2%) elective operations in groups A and B, respectively. Regarding treatment, in group A, patients requiring colostomy had transverse loop colostomy, while in group B, sigmoid (usually divided) colostomy was preferred. The definitive surgery done during the two periods were: group A: cutback anoplasty 29 (47.5%), anal transplant 5 (8.2%), sacroabdominoperineal pull through (Stephen's operation) 6 (9.5%) and others 21 (34.4%). In group B, posterior sagittal anorectoplasty (PSARP) 46 (83.7%), anal transplant 1 (1.8%), posterior sagittal anorectovaginourethroplasty (PSARVUP) 2 (3.6%) and anal dilatation 6 (10.9%) were done. Early colostomy-related complication rates were similar in the two groups (P > 0.05). The overall late complication rate was 65.5% in group A and 16.4% in group B (P < 0.05). The mortality was 25 (18.6%) in group A compared to 17 (10.6%) in group B (P < 0.05).
  
  
  CONCLUSIONS
  There have been significant changes in the management of anorectal malformations in this centre in the last two decades, resulting in improved outcomes.
authors.affiliation: Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
authors.forename: C S
authors.initials: CS
authors.lastname: Lukong
authors.forename: E A
authors.initials: EA
authors.lastname: Ameh
authors.forename: P M
authors.initials: PM
authors.lastname: Mshelbwala
authors.forename: B A
authors.initials: BA
authors.lastname: Jabo
authors.forename: A
authors.initials: A
authors.lastname: Gomna
authors.forename: O T
authors.initials: OT
authors.lastname: Akiniyi
authors.forename: P T
authors.initials: PT
authors.lastname: Nmadu
mesh_terms: D001003:Anal Canal / Q000002:abnormalities* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D003125:Colostomy / Q000401:mortality / Q000639:trends; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009549:Nigeria / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000401:mortality / Q000639:trends; D012007:Rectum / Q000002:abnormalities* / Q000601:surgery*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome