Short-term outcome of one-stage sphincter-saving anterior sagittal anorectoplasty in vestibular and perineal fistulae in female infants

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Abstract

Background/aim
Vestibular and perineal fistulae are the most common anorectal malformations in female infants. The progress in surgical correction has been aimed at achievement of both good continence and cosmetic outcome. This study aimed to present two-center experiences in one-stage sphincter-saving modification of anterior sagittal anorectoplasty for vestibular and perineal fistulae in female infants.
Patients and methods
This prospective study was conducted on 38 patients. They were divided into vestibular and perineal groups. The position of anus was marked by Peña stimulator, and traction suture were placed around the fistula. With longitudinal midline perineal incision, separation of the rectum from posterior vaginal wall. The center of anal sphincter muscle complex was identified and the rectum was passed through it, finally anoplasty with reconstruction of perineal body. Continence was evaluated by Krickenbeck and Holschneider scores in patients older than 3 years.
Results
The mean age was 60.26 days. The mean operative time was 109.61 min. The rectum was passed through the intact sphincter in all cases. A total of three (7.89%) cases developed superficial wound dehiscence that was treated conservatively, one (2.63%) case needed colostomy and anal dilatation was done for 3 months, one (2.6%) case developed anal stenosis corrected by anoplasty, and five (13.15%) cases developed minor mucosal prolapse, with spontaneous improvement. Constipation occurred in six (15.78%) patients and was controlled by diet modification and laxatives. Good continence was obtained.
Conclusion
One-stage sphincter-saving anterior sagittal anorectoplasty is safe and feasible technique in vestibular and perineal fistulae in female infants. The short-term outcome show good cosmetic and functional results regarding continence.

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