Early results of different types of anorectoplasty for anorectal malformations

Mizanur Rahman,Most Dalia Akhter,Zafor Sharif,Tarikul Islam

doi:10.3329/mediscope.v8i2.55313

Abstract

Objective: To document our experience with the technique of surgical repair in anorectal malformations (ARM) and the short term anatomical and functional outcomes. Methods: This study included total 31 babies. Fourteen were perineal fistula cases with age range between 1 to 4 days. Ten patients had vestibular fistula and seven had rectourinary fistula. Primary diverting colostomy was done for vestibular and rectourinary fistula patients. On the other hand low imperforate anus with anoperineal fistula without associated major anomalies had undergone fistulectomy and simple anoplasty. Results: Simple anoplasty was done for fourteen perineal fistula cases. Anterior sagittal anorectoplasty (ASARP) was done for 10 vestibular fistulae and posterior sagittal anorectoplasty (PSARP) was done in 10 recto-urinary fistula cases. Simple anoplasty and vestibular anus scored good (5-6) in 70% to 71% while PSARP scored fair in 58% of the cases. Postoperative mucosal prolapse, anal stenosis and retraction occurred in two, six and one patient respectively. Redo surgery was done in mucosal prolapse and retraction cases. Four responded to anal dilation and the other needed redo surgery by a simple cutback technique for anal stricture. Continence was assessed in 23 patients whose follow-up periods were longer than 3 years. Twenty one patients had a good score and two had a fair score. No patients had a poor score. Conclusion: Our approach has the following advantages: (i) The operative technique is simple and easy to perform. (ii) Minimal complication rate with good cosmetic results. Mediscope 2021;8(2): 75-79

Highlights

Anorectal malformations (ARMs) encompass a spectrum of congenital anomalies involving the rectum, urinary tract, and the reproductive structures with varying degrees of complexity
Presentations may vary from simple low malformations like perineal fistula which can be treated by simple cutback anoplasty to high complex malformations which requires difficult and challenging multi-staged operative procedures
This study was performed to document our experience in the short-term results and to evaluate early anatomical and functional outcomes of anoplasty and anterior sagittal anorectoplasty (ASARP)/posterior sagittal anorectoplasty (PSARP) in ARM patients

Summary

Introduction

Anorectal malformations (ARMs) encompass a spectrum of congenital anomalies involving the rectum, urinary tract, and the reproductive structures with varying degrees of complexity. It has been continuing to present a challenge for the pediatric surgeons. Presentations may vary from simple low malformations like perineal fistula which can be treated by simple cutback anoplasty to high complex malformations which requires difficult and challenging multi-staged operative procedures. PSARP represents the exposure of structures under direct vision and restoration of the normal anatomical relationships between structures. It is the well established and the gold standard procedure for the definitive treatment of ARM patients.[7,8,9] This study was performed to document our experience in the short-term results and to evaluate early anatomical and functional outcomes of anoplasty and ASARP/PSARP in ARM patients

Methods

Results

Conclusion