The application of blind punch-assisted pull through of rectal muscle sheath for the treatment of anal atresia combined with urethral fistula in children

Abstract

Objective To explore the feasibility and efficacy of blind punch assisted pull through of rectal muscle sheath for the treatment of anal atresia combined with urethral fistula in children.Methods A total of 112 patients with anal atresia combined with urethral fistula were recruited in this study.Group A consisted of 48 patients,who were performed blind punch-assisted pull through of rectal muscle sheath surgery.Group B included 64 patients,who underwent posterior sagittal anorectoplasty.Their defecation function was followed up to evaluate surgical efficacy.Results In group A,38 children (79.2％) achieved satisfactory defecation function after surgery compared with 55 children (85.9％) in group B.In group A,36 patients (75％) had satisfied external anal sphincter contraction,which is not significantly different from that in group B (75％ vs 85.9％,P＞0.05).Three patients (6.3％) presented constipation in group A,compared with 15 (23.4％) in group B (P＜0.05).During follow-up,complications of group A consisted of anorectal stenosis in 2,urinary fistula in 1,urethral strictures in 2,and rectal mucosal prolapse in 5.In group B,complications included anorectal stenosis in 6,urinary fistula in 1,and urethral stricture in 10.The incidence of postoperative complications was not significantly different between the 2 groups.Conclusions Blind punch-assisted pull through of rectal muscle sheath is feasible and efficient for the treatment of anal atresia combined with urethral fistula in children. Key words: Anus, imperforate; Urethra; Fistula; Surgical procedures, operative