Outcomes of Single-Stage Posterior Sagittal Anorectoplasty in Patients with Imperforate Anus and Rectovestibular Fistula

Abstract

Background: Malformations of the anorectum include a series of congenital lesions, ranging from a slight malposition of the anus to complex anomalies of the hindgut and urogenital organs. An anorectal malformation (AMR) occurs in one out of every 4000 to 5000 newborns and is slightly more common in males. There is specific cause of AMR has been described. The most frequent defect in males is imperforate anus with a recto urethral fistula while in females is a recto vestibular fistula. Imperforate anus without a fistula is unusual defect, occurring in about 5% of the entire group of malformations, and is associated with Down syndrome. Aim of study: This prospective study was undertaken to evaluate the safety and feasibility of primary anorectoplasty without a covering colostomy using the posterior sagittal anorectoplasty (PSARP) technique in patients having vestibular fistulae, its complications, results, and outcome. Methods: From January 2012 to November 2014, 20 patients with imperforate anus and vestibular fistulae subjected to single-stage surgical correction at Children Welfare Hospital in Medical City in Baghdad were followed prospectively for six months. Patients who had undergone a staged repair were excluded from the study. All patients were assessed for complications including stenosis, infection, prolapse, excoriation, dehiscence and constipation. Results: Mortality was nil. Constipation (5%). anal stenosis (10%), mucosal prolapse (10%), superficial wound infection (10%), wound dehiscence (5%), and excoriation (5%). Apart from one patient who needed re-do operation with protective colostomy, all patients with complications were successfully managed by local wound care, antibiotics, laxatives, enema, anal dilatation, and dietary changes. Conclusion: Single stage anoplasty without protective colostomy can be done safely and effectively as 3 stages operation in patients with imperforate anus and recto vestibular fistula in selected patients with fewer burdens on the baby and family.