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Primary anterior sagittal anorectoplasty for rectovestibular fistula
Md Abdul Aziz1, Tahmina Banu, Ramanandan Prasad
1Department of Paediatric Surgery, Dhaka Shishu (Children) Hospital and Bangladesh Institute of Child Health, Dhaka, Bangladesh. draaziz@aitlbd.net
Insights
Primary anterior sagittal anorectoplasty (ASARP) offers a quick, cost-effective solution for rectovestibular fistula (RVF), avoiding colostomy and improving patient outcomes.
Area of Science:
- Pediatric Surgery
- Anorectal Malformations
Background:
- Rectovestibular fistula (RVF) presents significant morbidity and treatment challenges.
- Staged management protocols for RVF can be lengthy and costly.
Purpose of the Study:
- To evaluate the efficacy of primary anterior sagittal anorectoplasty (ASARP) for rectovestibular fistula (RVF).
- To reduce patient suffering and treatment costs associated with RVF.
Main Methods:
- A prospective study involving 23 patients with RVF (18 congenital, 5 acquired) aged 15 days to 5 years.
- Diagnosis confirmed via history, clinical examination, and ultrasonography.
- Primary ASARP performed without colostomy, laparotomy, or laparoscopy.
Main Results:
- Mean operative time was 90 minutes with no major perioperative complications.
- Three patients experienced partial wound disruption; all tolerated oral feeding by postoperative day 4.
- Mean hospital stay was 6 days, with 3-5 daily bowel movements and minimal soiling.
Conclusions:
- Primary ASARP is a safe, effective, and cost-efficient surgical option for RVF.
- This single-stage procedure eliminates the need for colostomy, simplifying management.
Objective:
To reduce the morbidity and suffering of patients with rectovestibular fistula (RVF) and to lessen the cost of the staged management protocol.
Methods:
A prospective study was carried out in the Department of Paediatric Surgery of Dhaka Shishu (Children) Hospital, Bangladesh, from January 2002 to February 2004. Twenty-three patients underwent primary anterior sagittal anorectoplasty (ASARP) for RVF, of whom 18 had congenital and five had acquired RVF. Patient age ranged from 15 days to 5 years. The diagnosis was made from history, clinical examination and ultrasonography.
Results:
The mean operating time was 90 minutes. There were no major perioperative complications. Three patients developed partial wound disruption in the postoperative period. All patients started oral feeding on the 4th postoperative day and the mean hospital stay was 6 days. The average bowel movements per day were 3-5 motions, without any oral therapy or enema. Two patients had occasional perineal soiling. All patients are being followed-up and the early postoperative results seem acceptable.
Conclusion:
Primary ASARP is a good procedure for RVF as it is quick and cost-effective and requires no colostomy, laparotomy or laparoscopy.
