Trans-sphincteric anorectoplasty for rectovestibular fistula

Abstract

Abstract:

Introduction:

     Imperforate anus with rectovestibular fistula is the most common form of the imperforate anus in females and is an intermediate type of this disease, which is treated surgically(2). Generally, patients with vestibular fistulas have good functional results when treated by fistula transposition (8).

Materials and methods:

This was a prospective study did from January 2016 to January 2017. We included all female with age range from (25 days -12years old) diagnosed as a rectovestibular fistula (RVF) operated by single stage TSARP, at pediatric surgery units of Assiut and Aswan university hospitals. The functional results, cosmetic appearance and postoperative complication for each case after treatment were evaluated in patients for 3-6 months.

Results:

The total numbers of cases are 22 cases from rural areas of Upper Egypt, (36.36%) of patient's fathers and mothers are relatives and have associated anomalies. (50%) of cases are complaining of recurrent attack of constipation. (45.5%) of cases developed wound infection at the neoanal site. 7 cases are now more than 3years old, 6 of those 7 cases achieved voluntary bowel control and toilet trained and have good (4-5 points) wing spread score. One case less than 3 years old also achieved voluntary bowel control and toilet trained and has good (5 points) wing spread score.

Conclusion:

Trans-sphincter anorectoplasty (TSARP) is easy to perform with reasonable operative time, good cosmetic and functional outcome. Separation of the rectum from the posterior wall of the vagina is the most delicate step of the operation, takes place under direct vision. Constipation is an essential problem in patients that can be managed by laxatives. Meticulous post-operative wound care is essential.