Single stage repair of anovestibular fistula in neonate

Anorectal malformations are one of the most common congenital defects. This study is conducted to evaluate the result of single stage anterior sagittal anorectovaginoplasty (ASARVP) in cases of vestibular anus (AVF) in neonatal age group without thorough gut preparation. All the patients of AVF admitted during 2003-2006 were included in this study. Single stage ASARVP was done in these patients without preparing the bowel in the lithotomy position, the fistula was freed and sufficient length of anorectum was dissected and vagina was separated. Midline incision at the proposed anal site was made, then a plane was dissected between the muscle complex going anteriorly. The mobilized anorectum was pulled to the proposed anal site and proper anoplasty was done. The results were evaluated for duration of surgery, need of bowel preparation, commencement of feed and hospital stay and follow-up (assessment of continence and anal dilatation). A total of 27 patients were included in our study. All patients were less than 1-month-old. Operative time ranges from 50 to 70 min. Bowel preparation was not needed. Per oral feed was started after 48 h in all patients and average duration of hospital stay was 3- 4 days. Postoperative regular anal dilatation was commenced after 1 week of operation. Continence results according to Kelly's method were good in 70%, fair in 21% and poor 9%. Single-stage anorectovaginoplasty in neonates has a good result in cases of AVF and avoids the need of bowel preparation.