Original article
Single-stage repair of vestibular and perineal fistulae without colostomy

https://doi.org/10.1016/j.jpedsurg.2008.03.047Get rights and content

Abstract

Purpose

This retrospective study was undertaken to evaluate the feasibility of primary anorectoplasty without a covering colostomy using the anterior sagittal anorectoplasty (ASARP) or posterior sagittal anorectoplasty (PSARP) technique in patients having vestibular and perineal fistulae, its complications, results, and remote outcome in our institute.

Methods

From January 2000 to June 2007, patients with vestibular and perineal fistulae subjected to single-stage surgical correction at our institute were reviewed retrospectively from the data available in hospital records and follow-up complaints of patients and their parents in the outpatient department. Patients who had undergone a staged repair were excluded from the study. All patients were assessed for immediate and delayed complications including continence of the neorectum.

Results

From January 2000 to June 2007, 123 patients having vestibular (94) and perineal fistulae (29), age range from 28 days to 10 years, were subjected to primary repair either by the ASARP (34) or PSARP (89) technique. Follow-up period ranged from 3 months to 7 years. Mortality was nil. Constipation (25.68%) was the major long-term problem. Incontinence occurred in 1 patient (1.85%), who also had associated sacral agenesis. A total of 98.15% of patients were continent with stool frequency of 1 to 4 per day. Recurrence of fistula (0.81%), anal stenosis (6.76%), mucosal prolapse (2.70%), and anterior migration of the neoanus (1.35%) were the other major problems. Other minor problems like wound infection, superficial wound dehiscence, transient constipation, and diarrhea, etc, were successfully managed by local wound care, antibiotics, laxatives, enema, anal dilatation, and dietary changes.

Conclusion

Primary anorectoplasty either by PSARP or ASARP is feasible in vestibular and perineal fistulae without covering colostomy. Associated sacral agenesis/hypoplasia, redundant rectosigmoid or pouch colon, and wound infections with dehiscence are the major confounding factors affecting overall outcome. Better outcome in terms of continence can be achieved by careful surgical technique and follow-up along with proper toilet training. Complication rate was greater in cases of vestibular fistula than of perineal fistula, regardless of technique used. Some sort of laxatives and enema are often required. Dilatation of the neoanus for varying periods is also needed.

Section snippets

Aim and objectives

This retrospective study was undertaken to evaluate the feasibility of primary anorectoplasty without a covering colostomy in patients having vestibular and perineal fistulae, either by the anterior sagittal anorectoplasty (ASARP) or the posterior sagittal anorectoplasty (PSARP) technique. The short- and long-term complications, results, and remote outcome of these techniques (ASARP or PSARP) in our institute have been mentioned for single-stage repair of vestibular and perineal fistulae. We

Material and method

The hospital records of all the patients with vestibular and perineal fistulae subjected to single-stage surgical correction either by ASARP or PSARP at our institute during January 2000 to June 2007 were evaluated retrospectively. All patients were assessed for immediate and delayed complications including continence of the neorectum. The classification of anomaly is based on the Krinkenbeck Conference [1] on ARM in 2005.

Discussion

Anorectal malformations (ARM) constitute the most varied group of congenital defects. They affect approximately 1 in 3500 live births [2]. Vestibular fistula is the most common form of ARM in girls and is associated with the best prognosis. It is estimated that 93% of patients with vestibular fistula will develop voluntary bowel movements by the age of 3 years [3]. Because of increased cost of 3-stage operations [4], [5], especially in developing countries, and well-known problems with

Cited by (51)

  • Anorectal anomalies in the female: Highlights on surgical management

    2021, Journal of Pediatric Surgery
    Citation Excerpt :

    The value of colostomy is generally well appreciated in boys with rectourethral fistula (both diagnostic and therapeutic) [3]. Contrarily, in females with rectoperineal/vestibular fistula, the role of protective colostomy has been questioned as several reports have shown the feasibility of primary repair with comparable results [5,11,19–24]. Creating and closing a colostomy are 2 major operations representing a high price that should have a clear indication (advantage) in the management of rectoperineal/vestibular fistula [5].

View all citing articles on Scopus
View full text