anorectal anomaly with rectovestibular fistula: a historical comparison of neonatal anterior sagittal anorectoplasty without covering colostomy and postoperative anal dilatation to the classical three-stage posterior sagittal anorectoplasty

Dayang Anita Abdul Aziz,1 Ramamoorthy Velayutham,2 Marjmin Osman,1 Zarina Abdul Latiff,3 Felicia SK Lim,4 Mahmud Mohd Nor1 1Department of Surgery, UKM Medical Centre, Kuala Lumpur, 2Department of Surgery, Hospital Raja Permaisuri Bainun, Ipoh, 3Department of Paediatrics, 4Department of Anaesthesia, UKM Medical Centre, Kuala Lumpur, Malaysia Background: Traditional three-stage posterior sagittal anorectoplasty (PSARP) is a widely used operational technique for rectovestibular fistula (RVF) which includes creation of stoma, definitive surgery, and subsequent closure of stoma. Three-stage PSARP is usually completed during infancy. Many pediatric surgeons across the world have embarked on anterior sagittal anorectoplasty (ASARP) as an alternative technique to reduce pelvic floor dissection and the need to operate with patients in the prone position. ASARP is performed with the patient lying in supine position and it can be performed as one-stage repair during the neonatal period. Early reports from many centers are showing promising results. An outcome comparison of both techniques is vital to help surgeons consider this new approach in the repair of RVF.Patients and methods: This is a retrospective historical comparison study. Nine neonates with RVF underwent primary ASARP without postoperative anal dilatation and were compared to 25 patients with RVF who underwent three-stage PSARP with postoperative anal dilatation. Immediate surgical outcome was reviewed from the records and follow-up sheets of individual patients and functional outcome was assessed by interviewing the parents. Results were compared statistically; P-value ≤0.05 was considered significant.Results: The immediate surgical complications were higher in the PSARP group (40%) compared to the ASARP group (22%). Functional outcome showed overall better outcome in ASARP compared to PSARP. Patients from both groups did not develop stenosis, although only the PSARP group was subjected to daily anal dilatation.Conclusion: Primary neonatal ASARP without dilatation is a good technique for RVF in girls. Immediate complication rates were lower to those in PSARP. However, both immediate surgical and functional outcome between the ASARP and PSARP groups did not show overall statistical significance in this study. However, the ASARP technique has improved the ease of overall care of children with this condition. Keywords: neonate, anorectal anomaly, ASARP, PSARP