Abstract
Introduction: Despite a better understanding of the embryology, anatomy of anorectal malformations and of the physiology of continence, the management of children born with imperforate anus continues to be a surgical challenge and is still fraught with numerous complications and often leads to less than perfect qualitative results. Pediatric patients with recto-vestibular fistula have good prognoses in terms of bowel function when properly treated. Aim & Objective: The study was designed to assess the surgical morbidity of single stage Anterior Sagittal Anorectoplasty (ASARP). Methodology: This prospective study was carried for a period of 26 months. It included a total of 48 female patients (aged 0 - 14 years) with diagnosis of Anorectal Malformations (ARM) with vestibular fistula or perineal ectopic anus. In ASARP, Patient in lithotomy position, the anterior portion of sphincter muscles were cut through a midline perineal skin incision, rectum was separated from the vagina & then rectum was pulled through the center of these muscles. The perineal body was reconstructed and the normal appearance of perineum was achieved. Results: Short-term surgical outcome was satisfactory in all cases. No one needed colostomy. Conclusion: Single-stage ASARP is a good approach in experience hands for ARM with vestibular fistula and perineal ectopic anus in females and thereby complications and time involved in staged procedures including colostomy can be avoided. Key words: Anterior sagittal anorectoplasty, anorectal malformations, perineal ectopic anus, vestibular fistula. DOI: 10.3126/jnps.v30i1.2458 Journal of Nepal Paediatric Society Vol.30(1) 2010 37-43
Highlights
Despite a better understanding of the embryology, anatomy of anorectal malformations and of the physiology of continence, the management of children born with imperforate anus continues to be a surgical challenge and is still fraught with numerous complications and often leads to less than perfect qualitative results[3]
Primary Anterior Sagittal Anorectoplasty (ASARP) was performed from September 2004 to March 2009 (55 months) on 48 patients of anoretal malformations with vestibular fistula or perineal ectopic anus in Kanti Children’s Hospital and Ishan Children’s Nursing and Maternity Home (Table 1) their age range was from neonates (3 days) to five years old children (Table 2)
Previous operative procedures like cut back operation or its modification ‘ V-Y plasty’ for the repair of anovestibular fistula, have the disadvantage of the contamination of the vagina and urethra with consequent vaginitis and urethritis often results and soiling or staining due to mucosal involvement may occur at times[16,17]
Summary
Vestibular fistula and perineal ectopic anus are the most common anorectal malformations in female children[1]. The previously used surgical techniques include cutback, perineal anal transplant, YV plasty, sacroperineal repair, and colostomy followed by minimal posterior sagittal anorectoplasty. These procedures have been limited by incomplete anatomic exposure, blind tunneling of the rectum, lack of Journal of Nepal Paediatric Society. Reconstruction of the perineal body, need for a colostomy and a displeasing appearance of the perineum, with anterior migration of the anus in the long term. These limitations have been offset by ASARP1, 3. A number of pediatric surgeons repair this defect, primarily without a protective colostomy 6
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