Anterior sagittal anorectoplasty: An alternative to posterior approach in management of congenital vestibular fistula

Harjai, MM; Sethi, Navdeep; Chandra, Naveen

doi:10.4103/0189-6725.115027

Cited by 16 publications

(14 citation statements)

References 12 publications

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“…The cosmetic outcome as assessed by the appearance of perineum and calibration of neoanus was near satisfactory in all. Although the cosmetic outcome is reported to be the superior in ASARP,[ 2 8 9 ] we did not find much difference between the two procedures in our series. The two girls with wound dehiscence had an acceptable perineum following anoplasty.…”

Section: Discussioncontrasting

confidence: 63%

Anorectal malformations in adolescent females: A retrospective study

Rawat

Singh

Pant

2018

J Indian Assoc Pediatr Surg

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Context:While most of the females with anorectal malformations (ARMs) present in either neonatal period or early infancy, a small percentage presents in their adolescence.Aim:The aim is to study the causes of delay in presentation, management, and postoperative outcome in these cases.Settings and Design:This is a retrospective observational study conducted in the Department of Paediatric Surgery, King George's Medical University, Lucknow.Subjects and Methods:Records of females with ARM managed in one unit of the department from 2010 to 2015 were scrutinized. Of these, record of females who primarily presented in adolescence was reviewed. Data regarding the demographics, clinicoradiological presentation, management, postoperative stay, and follow-up were analyzed. Causes for delay in presentation were looked for.Statistical Analysis Used:Statistical analysis used was not required.Results:Out of 627 cases of ARM managed over 5 years, ten girls (5.3%) presented between 12 and 18 years (average 14.4 years). Main reasons for the delay in presentation were misinformation, illiteracy, and poverty. These comprised of anovestibular fistula (n = 5), anterior ectopic anus (n = 3), perineal canal (n = 1), and rectovestibular fistula (n = 1). Three (30%) girls had no problem apart from an abnormal anal orifice. Five (50%) girls had constipation as a major additional symptom. Four cases had a normal to mildly enlarged rectum on contrast study, whereas the rectum was moderately to hugely dilated in the remaining six cases. Six cases were managed with posterior sagittal anorectoplasty while an anterior sagittal anorectoplasty was done in four. Minor wound dehiscence developed in two cases. There was no mortality. In a mean follow-up of 16 months (8–26), constipation and soiling were seen in 5 (50%) girls. The overall outcome in these girls was satisfactory.Conclusion:Presentation of females with ARM in adolescence is not uncommon in the third world. A primary pull through is possible in these girls with mild-to-moderate rectal dilatations. A diverting colostomy before pull through is always a safe option in cases with severely dilated rectum and also otherwise. Moreover, a greater awareness regarding these malformations in the general public is required.

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Section: Discussioncontrasting

confidence: 63%

Anorectal malformations in adolescent females: A retrospective study

Rawat

Singh

Pant

2018

J Indian Assoc Pediatr Surg

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“…However, very few studies directly compared the outcome following PSARP and ASARP. 17,19 Our study addresses this issue. It describes the postoperative results and bowel function after PSARP and ASARP in a well matched cohort.…”

Section: Discussionmentioning

confidence: 96%

Comparative study of outcome following primary posterior sagittal ano-rectoplasty and primary anterior sagittal ano-rectoplasty for vestibular fistula

Saoji

Nagdeve

2018

Int Surg J

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Background: To compare the postoperative complications and bowel function following primary PSARP and primary ASARP.Methods: This prospective study was carried out over a period of 4 years. Patients above 4 months, who needed surgical repair for vestibular fistula were included in study. They were randomly allocated into PSARP group and ASARP group. After surgical intervention, patients of both groups were compared with respect to post-operative complications, voluntary bowel control, constipation, need for laxatives.Results: 44 patients were enrolled in the study. Of these, 22 patients were allocated to primary PSARP group while remaining patients underwent ASARP. One patient from each group was lost to follow‑up and hence, excluded from the final analysis. The two groups were comparable with respect to age, maturity at birth, weight at the time of surgery, blood investigations. Total 16 patients had associated congenital anomalies. During the postoperative period, four patients from PSARP group and two patients from ASARP group had superficial wound infection of perineal incision which was managed conservatively. One patient in PSARP group had a major breakdown of perineal wound with retraction of pulled rectum which required colostomy. There was no recurrence of fistula in any patient. No patient had stenosis of neo-anus or anterior displacement of rectum. Functional assessment of bowel function was done in 25 patients who completed 3 years of age. Voluntary bowel movements were observed in 75% of cases in the ASARP group compared to 38 % in PSARP group. 15% patients of PSARP group and 7.5% patients with ASARP had soiling. Though the difference was not statistically significant, nearly 38% of the patients after PSARP, needed laxative for normal bowel habit compared to 8% patients in ASARP group.Conclusions: ASARP promises many advantages in the treatment of vestibular fistula in comparison to PSARP. Comparable post-operative complications, good cosmetic results, excellent continence with less need for laxatives are the advantages of ASARP.

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“…Soon this became very popular owing to its good exposure during surgical procedure and good anatomical and physiological outcomes. But the inverted jack knife position during PSARP was difficult to manage for anesthetists and surgeons 1,5 . Apart from difficulty in maintaining intravenous access, it has risk of endotracheal tube dislodgement, eye injury, femoral nerve compression and spine hyperextension.…”

Section: Discussionmentioning

confidence: 99%

“…Apart from difficulty in maintaining intravenous access, it has risk of endotracheal tube dislodgement, eye injury, femoral nerve compression and spine hyperextension. Restricted abdominal movements during breathing in this position may lead to compromised ventilation and impaired cardiac output 5 . In 1992, ASARP was introduced by Okada and since then it is gaining popularity.…”

Section: Discussionmentioning

confidence: 99%

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Anterior Saggital Anorectoplasty

Rasool

Khan

Aslam

et al. 2018

TPMJ

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… Anorectal malformation is the common congenital malformation. Ectopic anusand vestibular fistula are Intermediate types of anorectal malformations (ARM), which are themost common in female babies. Many surgical procedures have been described for the treatmentof ARM. Anterior Saggital Anorectoplasty (ASARP) is not only convenient for the anesthetist formaintenance of anesthesia but also gives better exposure of surgical structures during surgery.Objectives: To determine the technical suitability and outcome of ASARP in intermediate typesof ARM in female children. Design: This Descriptive study with prospective collection of dataaccording to a set protocol. Setting: The study was carried out at the department of PediatricSurgery, Military Hospital, Rawalpindi, Pakistan. Period: November 2010 to March 2014, overthe period of 3 years and 5 months. Patients and Methods: The data of all female patientspresenting with intermediate types of ARM and undergoing ASARP, during the study periodwere analyzed, with respect to age, type, associated anomalies, complications and cosmeticoutcome. Results: A total of 36 patients of intermediate variety underwent ASARP. Age rangedfrom 6 months to 22 years. All patients had colostomy prior to this procedure. During surgery,posterior vaginal wall tear occurred in 2 patients (5.5%). Postoperatively, 2 patients (5.5%) hadretention of urine, 2 patients (5.5%) developed wound infection with superficial disruption, analstenosis occurred in 2 patients (5.5%) and 1 patient (2.7%) had rectal mucosa prolapse. Noneof them required re_ do surgery. Cosmetic outcome was excellent in 31 patients (86.1%), while itwas satisfactory in 5 (13.8%) patients. Conclusions: Anorectoplasty through anterior approachis not only technically easy but has good cosmetic results in intermediate type of imperforateanus in female children.

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Anterior sagittal anorectoplasty: An alternative to posterior approach in management of congenital vestibular fistula

Abstract: Anesthesia and access in ASARP makes it an easier alternative option to PSARP in the management of anovestibular fistula in girls.

Cited by 16 publications

References 12 publications

Anorectal malformations in adolescent females: A retrospective study

Anorectal malformations in adolescent females: A retrospective study

Comparative study of outcome following primary posterior sagittal ano-rectoplasty and primary anterior sagittal ano-rectoplasty for vestibular fistula

Anterior Saggital Anorectoplasty

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