Anterior sagittal anorectoplasty with external sphincter preservation for the treatment of recto-vestibular fistula: A new approach

Abstract

Context:To our knowledge, there is no description of anterior sagittal anorectoplasty (ASARP) with external anal sphincter preservation and passing neorectum in the middle of muscle complex under direct vision for the treatment of recto-vestibular fistula (VF).Aim:This study evaluates a new modification combining ASARP with under vision sphincter preservation.Subjects and Methods:This prospective study was conducted on thirty female infants with VF. Procedure starts with a vertical midline incision extending from ectopic opening to posterior limit of external sphincter. Sharp dissection of the fistula is carried out. Artery forceps is passed at the center of muscle complex under vision, then neorectum is placed in the middle of the muscle complex. We introduced a new scoring system based on parental interview assessing functional outcome. Each patient was given a score between 0 and 20; good: 14–20, fair: 7–13, and poor: 0–6.Results:ASARP was performed at a mean age of 2.6 months, a mean weight of 5.2 kg, a mean operative time of 102 min, and a mean hospital stay of 3.6 days. Wound infection occurred in four cases, seven cases had perianal excoriations, six cases had anal stenosis, and only one case complained of anal displacement. Patients followed for a mean of 18.8 months. Majority of our patients (50%) had good score (mean = 16.8), normal frequency, no or mild soiling, normal anal position with no or mild stenosis. Fourteen patients had fair score (mean = 10.5). Only one had poor outcome with severe soiling and perineal excoriation.Conclusion:Our modification offers optimal correction, with minimal sphincteric damage, without additional complexity or difficulties. Scoring system is simple, practical, and truly reflects early functional and parent satisfaction after surgery.

The early outcome of primary anterior sagittal approach for low anorectal malformations in female patients

“…First, in lower anomalies, the rectal pouch has already passed through the sphincter complex and second, in the ASARP, the sphincter is cut in anterior aspect only and the rectal pouch is placed in the center of sphincter leading to sphincter preservation. [17][18][19] In long-term follow up, adequate and strong perineal body between the rectum and vagina is of great importance for prevention of recurrent urinary tract infection, damage perineum and recurrent rectovaginal fistula in adult life. 20…”

Outcome of Single Stage Sphincter Sparing Scarless ( 5s) Procedure for Rectovestibular Fistula: A Retrospective Analysis

“…Most reports categorise RVF as a low anomaly; but Heinen has mentioned RVF as an intermediate anomaly [2]. Many operative techniques have been described for its correction including cutback, anal transpositioning [3], posterior sagittal anorectoplasty (PSARP), and anterior sagittal anorectoplasty (ASARP), in which the external anal sphincter is cut but puborectalis sling is not disturbed [4][5]. There are some other techniques like neutral sagittal anorectoplasty (NSARP) and transfistula anorectoplasty (TFARP) [5].…”

“…Many operative techniques have been described for its correction including cutback, anal transpositioning [3], posterior sagittal anorectoplasty (PSARP), and anterior sagittal anorectoplasty (ASARP), in which the external anal sphincter is cut but puborectalis sling is not disturbed [4][5]. There are some other techniques like neutral sagittal anorectoplasty (NSARP) and transfistula anorectoplasty (TFARP) [5]. Wang et al mentioned modified ASARP with the use of endoscopic visualization to avoid damaging the external anal sphincter [6].…”