Gynecologic anatomic abnormalities following anorectal malformations repair

Area of Science:

• Pediatric Surgery
• Gynecology
• Reconstructive Surgery

Background:

• Patients undergoing posterior sagittal anorectoplasty (PSARP) for anorectal malformation (ARM) may develop gynecologic issues.
• Common findings include inadequate perineal body, introital stenosis, retained vaginal septum, and rectovestibular fistula.
• These issues can impact fecal continence, sexual function, and delivery mode recommendations.

Purpose of the Study:

• To describe the experience with female patients referred for evaluation after prior ARM repair.
• To focus on perineal body anatomy and associated gynecologic abnormalities.
• To outline the collaborative evaluation, repair process, and outcomes.

Main Methods:

• Retrospective chart review of female patients requiring reoperative perineoplasty after ARM repair.
• Multidisciplinary evaluation by colorectal surgery, urology, and gynecology.
• Inclusion of examination under anesthesia (EUA) with cystoscopy, vaginoscopy, and electrical stimulation.

Main Results:

• 15 patients met inclusion criteria; most had prior rectovestibular fistula repair.
• Inadequate perineal body was the primary indication for reoperation.
• Concomitant gynecologic abnormalities requiring intervention included introital stenosis, retained vaginal septum, and remnant rectovestibular fistula.

Conclusions:

• Previously repaired ARM can lead to gynecologic concerns requiring surgical intervention.
• Inadequate perineal body is common, alongside other abnormalities like introital stenosis and retained vaginal septum.
• Multidisciplinary evaluation is crucial for optimal patient outcomes.