anterior sagittal anorectoplasty technique [ASARP] for treatment of recto-vestibular fistulae and vestibular anus in neonates and infants

ABSTRACT

Many surgical techniques have been described for functional treatment of vestibular anus, and recto-vestibular fistula in girls. Achievement of good results remains the main goal of treatment. Anterior sagittal anorectoplasty [ASARP] technique avoids dividing the pelvic floor, thus promises better postoperative continence. In this study, we evaluated the results of the ASARP technique in treatment of vestibular anus, and recto-vestibular fistula in neonates and children. In the period between May 2000, and May 2003, twenty female patients with anorectal anomalies [12 cases with vestibular anus, and eight cases with rectovestibular fistula] were treated by the ASARP technique in the pediatric surgery unit, Elshatby hospital, Alexandria University. Five cases were neonates. In all cases, the procedure was performed without protective colostomy. Median follow-up was 18 months [range 6- 28 months]. External appearance of the perineum and posterior fourchette was satisfactory in all patients, with no evidence of wound infection. No anterior anal migration, or retraction of the anal mucosa was detected. One case showed mild mucosal prolapse. Electrical stimulation revealed satisfactory contraction at the site of the new anus in all patients. Anal calibration revealed no anal stenosis. Continence score showed good score [3.5-5] in all assessed patients [nine]. No constipation or fecal impaction was recorded. The ASARP technique possesses many advantages in the treatment of vestibular anus and the rectovestibular fistula. Perineal dissection is more precise and yields excellent cosmetic results. It also obviates the need for pelvic colostomy and associated with minimal postoperative morbidity, with shortened postoperative hospital stay. In addition, it can be safely applied in the neonatal period. Excellent continence was achieved in all assessable cases