Anterior sagittal anorectoplasty for anovestibular fistula

Abstract

Anterior sagittal anorectoplasty (ASARP) was used for the definitive correction in 107 cases of anovestibular fistula (AVF) between 1996 and 2005. These cases were subjected to three different types of treatment regimes during the same period. Majority of the cases (78) were operated in one stage where postoperatively an early oral feed was started (A). Cases were discharged in 2-4 days. In the second group (B), there were ten cases who were also operated in one stage but with prolonged fasting of 9-10 days postoperatively. Nineteen cases (C) were operated under cover of colostomy during the same period. In the immediate postoperative period, among the group A, one case had a major wound disruption requiring a colostomy and a redo surgery. Three cases had subcutaneous leak. In seven cases there was premature dehiscence of mucocutaneous or skin sutures. In groups B and C, there were no significant complications in the immediate postoperative period. In the follow-up period, out of 107 cases, 63 (58.8%) had constipation at the end of 3 months. However, at the end of one year, only 24.3% (26 cases) cases had constipation. Regarding fecal continence, 86 cases (90.5%) were totally continent. Seven had history of occasional soiling and in two cases, soiling was more frequent. As far as repair or correction of AVF or vestibular anus is concerned, we feel that anterior sagittal approach is more suitable as it requires less pelvic dissection. Separation of posterior vaginal wall from rectum, which is considered, is the most important step of the operation, takes place under direct vision. We also feel that AVF can be repaired in one stage with an early postoperative oral feed, provided we are meticulous in pre and postoperative bowel management. It reduces hospital stay and the cost of treatment. This provides a good option to cases who are not able to afford prolonged hospitalization (fasting) or are not willing for a colostomy.

Anorectal Malformation Female Children One Stage Procedure Asarp

“…(8,9) Various surgeons have reported that there is no significant difference in multistage and single stage procedure. (10)(11)(12)(13)(14)(15)(16)(17) Our series is small for statistical analysis, but the results are in accordance with these reported series outcome in terms of continence can be achieved by careful anterior sagittal surgical dissection. Anovestibular fistula can be repaired in one stage with meticulous pre-and postoperative bowel management.…”

Rectovestibular fistula – diagnosis by radiological evaluation: a case report

“…The surgical management is warranted after the colostomy. Posterior sagittal anorectoplasty (PSARP) is performed as a choice [5][6][7]. There is always fear of stool incontinence because of the anal sphincter problems.…”

Primary Anterior Saggital Anoplasty in Female Anorectal malformation

“…Other advantage of this approach is that it can be done under caudal anesthesia. Okada 3 and Sanchez 4 have recommended prolonged fasting and TPN; however it requires prolonged hospitalization and has poor patient tolerance and passage of hard stool which may harm suture line 5 . We agree with Whaklu et al 6 in…”