SURGICAL TREATMENT OF ANORECTAL MALFORMATIONS IN CHILDREN: AN IMRAD-BASED CLINICAL STUDY

Abstract

Background: Anorectal malformations (ARM) are among the most important congenital anomalies in pediatric coloproctology. They occur worldwide with an estimated frequency of approximately 1:4,000-1:5,000 live births and are often associated with urogenital, vertebral, cardiovascular and other gastrointestinal anomalies.

Objective: To analyze the diagnostic structure, surgical treatment tactics and early clinical outcomes in children with congenital anorectal malformations treated in a specialized pediatric surgical center in Tashkent, Uzbekistan.

Materials and methods: This retrospective-prospective clinical study included 56 children with ARM treated during 2023-2025 at the Republican Scientific and Practical Center for Pediatric Minimally Invasive and Endoscopic Surgery, Tashkent, Uzbekistan. Patients were classified according to the Krickenbeck classification. Diagnostic evaluation included clinical examination, laboratory tests, abdominal and retroperitoneal ultrasonography, chest and abdominal radiography, Wangensteen-Rice and cross-table lateral radiography, fistulography, distal colostography, proximal irrigography through the stoma, cystography, excretory urography, gastrointestinal contrast passage studies, magnetic resonance imaging, multislice computed tomography, neurosonography, echocardiography and consultations with relevant specialists.

Results: Among 56 patients, 46 were boys and 10 were girls. Full-term birth was registered in 50 children, while 6 children were premature. Isolated ARM was found in 11 children, whereas 45 children had two or more associated congenital anomalies. The main clinical forms included atresia ani, atresia ani et recti, rectourethral fistula, rectovestibular fistula, rectoperineal cutaneous fistula, rectovesical fistula, cloaca, pouch colon and H-type anomaly. Signs of lower intestinal obstruction were detected in 53 patients. Low forms were treated primarily in selected cases, while high and complex forms required staged correction. Minimally invasive and laparoscopically assisted approaches improved visualization of pelvic anatomy and supported more precise placement of the rectum within the sphincter complex.

Conclusion: Effective treatment of ARM in children requires early diagnosis, accurate anatomical classification, screening for associated anomalies, individualized surgical planning and structured postoperative rehabilitation. Minimally invasive and laparoscopically assisted techniques may reduce operative trauma and improve functional and cosmetic outcomes when used in appropriate clinical forms.