Perineal canal repair using modified Tsuchida\u2019s technique

Abstract

BackgroundThe perineal canal is a rare variety of anorectal malformations, identified by different nomenclatures like H fistula, double termination of the alimentary canal, and anovestibular fistula. Various approaches to repair this anomaly have been proposed.The present study aimed to review the results of perineal canal repair with modified Tsuchida’s technique, in seven girls treated in our unit between 2014 and 2019. These were classified as acquired and congenital type of perineal canal, depending upon their clinical presentations.ResultsOf the total seven cases, it was found that three of them had a perineal abscess and persistent anovestibular fistula formation, and they underwent definitive repair of the perineal canal after 12 weeks as they did not respond to the conservative management. Four girls had congenital anovestibular fistula without infection. All the patients underwent covering colostomy and definitive repair by modified Tsuchida’s technique. One patient had a recurrence of the fistula, due to early closure of colostomy and underwent redo repair. One patient with known immune deficiency died before colostomy closure due to severe sepsis. During the last follow-up, all six girls were continent (Kelly’s score 6/6), and the perineum had healed well.ConclusionThe perineal canal can be acquired or congenital. Irrespective of its etiology, modified Tsuchida’s technique has been found to be an easy and satisfactory method of its repair.