One-stage trans-sphincter anorectoplasty: An effective approach for treating vestibular fistula in children

This study aimed to evaluate the effectiveness of Trans-sphincter Anorectoplasty (TSARP). By preserving the perineal body and avoiding perineal incisions, TSARP aims to improve both functional and cosmetic outcomes in pediatric patients with rectovestibular fistula (RVF).

A retrospective review of pediatric patients with rectovestibular fistula treated with TSARP at Children's Hospital 1 from January 2020 to December 2023 was conducted. Surgical procedures involved circumferential dissection of the fistula, precise rectovaginal separation, and placement of the neorectum through the center of the sphincter complex under direct vision. The Krickenbeck classification system evaluated postoperative bowel function. Parameters analyzed included operative time, complications, and long-term outcomes.

Among 67 patients, the median age at the time of surgery was 9 days (range: 2 days to 18 months), with a mean operative time of 50.9 ± 18.9 min. Reported complications included vaginal injuries (6.0 %), wound infections (1.5 %), and anal stenosis (3.0 %), all successfully managed conservatively. No rectal prolapse was observed. Recurrence of RVF was observed in 1.5 % of cases. Regarding bowel control, 34 children over 36 months of age were evaluated according to the Krickenbeck criteria, with one unable to withhold bowel movements, 5.9 % experiencing mild soiling, and 26.5 % having manageable constipation.

TSARP shows promising results as a minimally invasive technique for treating RVF in children. By preserving the integrity of the perineal body and avoiding perineal incisions, the technique reduces surgical trauma and promotes favorable functional and aesthetic outcomes. Further studies and long-term follow-up are needed to confirm its effectiveness and broader applicability.