The management of anorectal malformation with congenital vestibular fistula: a single-stage modified anterior sagittal anorectoplasty

Wang, Chen; Li, Long; Liu, Shuli; Chen, Zheng; Diao, Mei; Li, Xu; Wei, Cheng

doi:10.1007/s00383-015-3749-1

Cited by 19 publications

(15 citation statements)

References 21 publications

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“…[ 4 ] Original ASARP entails cutting of anterior rim of external anal sphincter. [ 5 ] Endoscopic guidance to preserve external anal sphincter adds complexity to ASARP,[ 10 ] while NSARP[ 8 ] entails opening the levator ani muscle, tackling fistula from inside the rectum, and nonreconstruction of the perineal body. TFARP[ 9 ] is similar to anal transposition without skin incision; it also has the disadvantages of poor reconstruction of the perineal body and blind tunneling of the anal sphincter.…”

Section: Discussionmentioning

confidence: 99%

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

Elsawaf¹,

Hashish²

2018

J Indian Assoc Pediatr Surg

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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.

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Section: Discussionmentioning

confidence: 99%

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

Elsawaf¹,

Hashish²

2018

J Indian Assoc Pediatr Surg

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“…There are several approaches for surgical repair of ARMs, and there are numerous reports on related complications. We reviewed previous reports on complications after surgery for ARM by the abdominal pull-through approach (Table 1 17,27 ), PSARP (Table 2 9 ,12,13,15,25-27,31-33 ), anterior sagittal anorectoplasty (Table 3 20,23 ), and LAARP (Table 4 10,13,24,29,[31][32][33] ). Previous reports that included multiple surgical approaches are excluded.…”

Section: Incidence and Description Of Complicationsmentioning

confidence: 99%

“…Leakage from suture lines (Figure 8), failed anastomoses, and perineal abscesses has been reported. 9,10,13,14 Infection after operation is a common complication, 9,10,13,14,20 and the diagnosis of leakage from the suture line is important in determining the best treatment option. Leaks may be detected with colonography, 9 whereas only one report has included radiographic images.…”

Section: Leakage From Suture Linesmentioning

confidence: 99%

“…Reports on postoperative complications of surgical repair of ARMs have documented the involvement of pelvic organs (such as anus, rectum, urethra, and vagina) as well as cutaneous structures. [9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] Various imaging techniques, such as plain radiography, colonography, voiding cystourethrography, ultrasonography, computed tomography, and magnetic resonance imaging (MRI) can be used for diagnosis. 9,11,16,18,19,21,29,30 Unlike surgeons, radiologists are often unfamiliar with ARMs and have little knowledge about the surgical procedures for their repair; to date, only one review article related to radiography has been published.…”

Section: Introductionmentioning

confidence: 99%

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Complications after Surgical Correction of Anorectal Malformations

Hosokawa

Yamada

Tanami

et al. 2020

Hong Kong Journal of Radiology

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Radiologists are often unfamiliar with anorectal malformations and have limited knowledge of the surgical procedures for their repair. In this article, we provide a comprehensible description of the surgical procedures for radiologists, review previous literature, and summarise the incidence of the complications. Moreover, we detail major postoperative complications consequent to the use of various imaging techniques, including anorectal prolapse, anal stenosis, urethral injury, posterior urethral diverticulum, neurogenic bladder, adhesion of reconstructed vagina, leakage from suture lines, and trocar site hernia. Knowledge of these complications and surgical procedures is important to radiologists for diagnosis and determination of a treatment strategy.

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“…Several studies have reported on the bowel outcomes after ASARP with a focus on patients with PF and VF. [56789] Furthermore, although several techniques have been practised by many centres in the treatment of ARM, there is still variation in the follow-up criteria used. Long-term outcomes of ARM have been reported using several different scoring methods.…”

Section: Introductionmentioning

confidence: 99%

Functional assessment of the patients with perineal and vestibular fistula treated by anterior sagittal anorectoplasty

Hashizume

Asagiri

Fukahori

et al. 2018

Afr J Paediatr Surg

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Background:Anterior sagittal anorectoplasty (ASARP) has been a standardised operative treatment for anorectal malformation (ARM). This retrospective study was undertaken to evaluate patients with perineal fistula (PF) and vestibular fistula (VF) treated by ASARP in our institution.Patients and Methods:Twenty patients (PF, n = 14; male, n = 8 and female, n = 6 and VF, n = 6) were evaluated. Eighteen patients underwent primary ASARP without protective colostomy. Two patients underwent colostomy because of intestinal atresia and suspected of other type ARM. The age range of operation was from 4 months to 5.0 years. Sixteen patients (PF, n = 13; male, n = 7 and female n = 6 and VF, n = 3) over 3 years of age were evaluated according to the Krickenbeck classification.Results:Operative complications occurred in one patient. Minor wound dehiscence occurred in six patients. Mucosal prolapse occurred in two patients. According to the Krickenbeck classification, amongst male patients with PF, all patients had voluntary bowel movements (VBMs) and two patients had Grade 1 soiling, while four patients had Grade 2 constipation. Amongst female patients with PF, all patients had VBM and no soiling, one patient had Grade 1 and two patients had Grade 2 constipation. In patients with VF, one patient was continent with Grade 1 soiling. One patient had Grade 2 and two patients had Grade 3 constipation.Conclusions:ASARP without colostomy carried a risk of wound dehiscence. The ASARP technique provided normal or moderate outcomes for VBM and soiling. However, in about half of patients, defecation management with laxative therapy was required to achieve a normal condition.

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The management of anorectal malformation with congenital vestibular fistula: a single-stage modified anterior sagittal anorectoplasty

Abstract: Mid-term results show that single-stage modified ASARP is an effective and safe option for patients with anorectal malformation and congenital vestibular fistula.

Cited by 19 publications

References 21 publications

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

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

Complications after Surgical Correction of Anorectal Malformations

Functional assessment of the patients with perineal and vestibular fistula treated by anterior sagittal anorectoplasty

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