Anterior Sagittal Anorectoplasty: Our Experience

Area of Science:

• Pediatric Surgery
• Surgical Techniques
• Anorectal Malformations

Background:

• Anterior sagittal anorectoplasty (ASARP) is a recognized surgical approach for vestibular fistula (VF) and low-type anorectal malformations (ARMs).
• Despite its acceptance, some reservations regarding ASARP persist in clinical practice.

Purpose of the Study:

• To detail the Anterior sagittal anorectoplasty (ASARP) technique for female pediatric patients with anorectal malformations.
• To evaluate the functional and cosmetic outcomes of ASARP in this population.
• To highlight key features and potential complications associated with the ASARP procedure.

Main Methods:

• A prospective study was conducted between 1992 and 2017.
• 157 female pediatric patients diagnosed with ARMs, including VF, perineal fistula, and rectovaginal fistula, underwent ASARP.
• Data collection focused on operative time, intraoperative and postoperative complications, and long-term functional and cosmetic results.

Main Results:

• The majority of patients (92.99%) presented with vestibular fistula (VF).
• ASARP demonstrated a high rate of satisfactory cosmetic outcomes (95.54%) with minimal need for secondary procedures (4.46%).
• Functional outcomes were generally good, with only one case of severe incontinence reported in a patient with associated myelomeningocele.

Conclusions:

• Anterior sagittal anorectoplasty (ASARP) is an excellent and effective procedure for treating vestibular fistulas in female pediatric patients.
• The technique provides optimal correction with minimal sphincteric damage and satisfactory cosmetic results.
• Primary ASARP is a rapid, effective approach that can avoid the need for colostomy with proper preoperative preparation and surgical expertise.