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Perineal canal
1Division of Pediatric Surgery, Department of Surgery, King George's Medical College, Lucknow, Uttar Pradesh, India.
Insights
Anterior sagittal anorectoplasty (ASARP) effectively treats rare perineal canal (PC) anomalies in children. This surgical approach leads to good functional outcomes, including normal bowel habits and fecal continence.
Area of Science:
- Pediatric Surgery
- Congenital Anomalies
- Gastroenterology
Background:
- Perineal canal (PC) is a rare anorectal malformation, accounting for 4% of cases.
- PC presents with fecal matter passage through both the anus and a fistula.
- Previous unsuccessful surgeries may complicate PC management.
Purpose of the Study:
- To evaluate the efficacy of anterior sagittal anorectoplasty (ASARP) for treating perineal canal (PC) anomalies.
- To assess the long-term functional outcomes and continence in patients undergoing ASARP for PC.
- To analyze the surgical management and outcomes of PC in a pediatric cohort.
Main Methods:
- Retrospective review of 60 patients with PC managed over 27 years.
- All patients treated with anterior sagittal anorectoplasty (ASARP).
- Surgical approach individualized based on perineal inflammation; primary ASARP or delayed surgery.
Main Results:
- ASARP allowed accurate repair in 60 patients (56 female, 4 male).
- 50 patients achieved fecal continence and normal defecation post-surgery.
- Long-term follow-up (up to 3 years) confirmed sustained continence and normal bowel habits in 34 patients.
Conclusions:
- Anterior sagittal anorectoplasty (ASARP) is a successful surgical technique for perineal canal (PC) anomalies.
- Individualized management via ASARP yields excellent functional results and continence.
- ASARP offers a reliable solution for this uncommon anorectal malformation.
Abstract:
Perineal canal (PC) is a rare anomaly constituting 4% of all anorectal malformations. Sixty patients (56 females and 4 males) with PC managed over the past 27 years are reported. The ages ranged from 2 days to 13 years. The chief symptom was passage of fecal matter through both the anus and the fistula. One girl had undergone previous, unsuccessful surgery. All our patients were treated by anterior sagittal anorectoplasty (ASARP), which allowed anatomic exposure and accurate repair of the anomaly. In 49 patients without any perineal inflammation primary ASARP was undertaken. Surgery was delayed in 11 patients with perineal excoriations and/or active inflammation. One patient died post-operatively due to unrelated causes and 1 developed a recurrence. Anal dilation was required in 7 cases. Fifty patients were seen at first follow-up 12 weeks after surgery. All were continent and had normal defecation without the use of laxatives. Thirty-four could be followed up to the age of 3 years; they were continent with normal bowel habits. There was no shift in the position of the anus and no instance of rectal dilation. Individualization of the management and operation by the anterior sagittal approach thus offers good results in this uncommon anorectal anomaly.