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Published on: January 7, 2019
Erudition from primary posterior sagittal anorectoplasty for anorectal malformations over two decades
1Department of Pediatric Surgery, All India Institute of Medical Sciences, Room No. 4001-2, New Delhi, India. drshilpas@gmail.com.
Insights
Primary Posterior sagittal anorectoplasty (P-PSARP) is a feasible surgical approach for anorectal malformations, yielding good functional outcomes with proper patient selection and perioperative care. Achieving proficiency requires a learning curve, but results demonstrate high rates of voluntary bowel movements.
Area of Science:
- Pediatric Surgery
- Anorectal Malformations
- Surgical Outcomes
Background:
- Anorectal malformations (ARMs) are congenital conditions requiring surgical correction.
- Posterior sagittal anorectoplasty (PSARP) is a common surgical technique for ARMs.
- Primary PSARP (P-PSARP) aims to correct ARMs in a single stage.
Purpose of the Study:
- To evaluate the perioperative and early postoperative outcomes of Primary Posterior sagittal anorectoplasty (P-PSARP).
- To assess the functional results, including bowel function and complications, following P-PSARP.
Main Methods:
- Retrospective analysis of patients who underwent P-PSARP between 2004 and 2019.
- Evaluation of perioperative care, management, and complications.
- Assessment of voluntary bowel movements, soiling, and constipation using Krickenbeck criteria.
Main Results:
- 156 patients (134 girls) underwent P-PSARP, with a median age of 5 months.
- Various types of fistulas and anal anomalies were observed in boys and girls.
- Complications included wound infection (6%), excoriation (4%), and anal stricture (4%).
- At follow-up, 84.2% achieved voluntary bowel movements, with 29.7% experiencing constipation and 6.5% soiling.
Conclusions:
- P-PSARP is a feasible surgical option for anorectal malformations.
- Proper case selection and meticulous perioperative care are crucial for successful outcomes.
- Achieving proficiency with P-PSARP involves a learning curve, but leads to satisfactory functional results.
Purpose:
Perioperative and early post-operative outcomes of Primary Posterior sagittal anorectoplasty (P-PSARP) were evaluated.
Method:
Retrospective analysis of cases who underwent P-PSARP from 2004 to 2019 was done. Perioperative care, management, complications, voluntary bowel movement, soiling and constipation, graded by Krickenbeck criteria were studied.
Results:
One hundred fifty six patients (134 girls) underwent P-PSARP at median age of 5 months (3 months to 14 years) in girls and 5(1-10) days in 21 boys. One male cloaca was operated at 5 months age. Of 20 boys, 5, 8, 4, 3 had rectobulbar urethral fistula, rectoprostatic urethral fistula, bladder neck fistula and male cloaca. Girls had vestibular fistula, rectovaginal fistula, vulval anus, anterior ectopic anus, pouch perineal fistulae and posterior anus with H type fistula in 114, 7, 6, 5, 1 and 1. Complications included wound infection, excoriation, oedema, mucosal prolapse, anal stricture, anal retraction and mortality in 6, 4, 5, 4, 4, 1 and 1, respectively. 35/155(12 neonates) required postoperative dilatations for 5(1-12) months. At follow-up, 96/114(84.2%) had voluntary bowel movements. 46/155 (29.7%) and 9/155 had constipation and soiling. 32:14:0 had grade 1:2:3 constipation, treated with diet (grade 1) and laxatives (grade 2) respectively. 4:3:2 had grade 1:2:3 soiling for initial 3 months, treated with bowel management programme.
Conclusion:
P-PSARP is feasible, subject to proper case selection and good perioperative care, once learning curve is achieved.
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