Abstract
Aim
To analyze our experience in the treatment of anorectal malformations (ARM) with the posterior sagittal anorectoplasty (PSARP), and our modifications through the last few years and the outcomes.
Materials and methods
We reviewed 107 cases divided into two groups: Former (F: 1994–2003) and Recent (R: 2004–2008). Type of ARM, associated anomalies, management and complications were noted. A telephone questionnaire regarding continence outcome was addressed to the 74 cases older than 3 years.
Results
According to the type of ARM, there were 53 perineal fistulas, 2 anal stenoses, 11 no fistulas, 12 rectourethral fistulas (5 rectobulbar and 7 rectoprostatic fistulas), 22 vestibular fistulas, 1 rectovesical fistulas and 6 cloacas. A total of 47 patients presented with 73 associated malformations. As much as 45 colostomies were performed, including 5 perineal fístulas, with 6 of 7 vestibular fístulas in group F and only 8 of 15 in group R. We had 19 complications of PSARP. The most frequent one was rectal mucosa prolapse in 14 (12F and 2R) and 2 wound infections (F). Continence was good in 62, poor in 3 and fair in 5. Seven out of eight children with poor or fair continence had associated malformations.
Conclusions
All perineal fístulas can be managed without colostomy. Vestibular fístulas can be safely treated without colostomy in otherwise healthy patients without severe malformations. Overall, continence is good, and fair/poor results are related to associated malformations. Cumulative experience helps avoid colostomies and reduce complication and reoperation rates.
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References
Holschneider A, Hutson J (2006) Anorectal malformations in children: embryology, diagnosis, surgical treatment, follow-up. Springer, Berlin
De Vries PA, Peña A (1982) Posterior sagittal anorectoplasty. J Pediatr Surg 17:638–643
Peña A, de Vries PA (1982) Posterior sagittal anorectoplasty: important technical considerations and new applications. J Pediatr Surg 17:796–811
Holschneider A, Hutson J, Peña A, Bekhit E, Chatterjee S, Coran A et al (2005) Preliminary report on the international conference for development of standards for the treatment of anorectal malformations. J Pediatr Surg 40:1521–1526
Peña A (1997) Total urogenital mobilization: an easier way to repair cloaca. J Pediatr Surg 32:263–268
Stephens FD, Smith ED (1986) Classification, identification and assessment of surgical treatment of anorectal anomalies. Pediatr Surg Int 1:200–205
Heinen FL (1997) The surgical treatment of low anal defects and vestibular fistulas. Semin Pediatr Surg 6:204–216
Albanese CT, Jennings RW, Lopoo JB, Bratton BJ, Harrison MR (1999) One-stage correction of high imperforate anus in the male neonate. J Pediatr Surg 34:834–836
Adeniran JO (2002) One-stage correction of imperforate anus and rectovestibular fistula in girls: preliminary results. J Pediatr Surg 37:E16
Liu G, Yuan J, Geng J, Wang Ch, Li T (2004) The treatment of high and intermediate anorectal malformations: one stage or three procedures? J Pediatr Surg 39:1466–1471
Menon P, Rao KLN (2007) Primary anorectoplasty in females with common anorectal malformations without colostomy. J Pediatr Surg 42:1103–1106
Upadhyaya VD, Gopal SC, Gupta DK, Gangopadhyaya AN, Sharma SP, Kumar V (2007) Single stage repair of anovestibular fistula in neonate. Pediatr Surg Int 23:737–740
Adeniran JO, Abdur-Rahman L (2005) One-stage correction of intermediate imperforate anus in males. Pediatr Surg Int 21:88–90
Zheng S, Xiao X, Huang Y (2008) Single-stage correction of imperforate anus with a rectourethral or a rectovestibular fistula by semi-posterior sagittal anorectoplasty. Pediatr Surg Int 24:671–676
Peña A, Migotto-Krieger M, Levitt MA (2006) Colostomy in anorectal malformations: a procedure with serious but preventable complications. J Pediatr Surg 41:748–756
Belizon A, Levitt MA, Shoshany G, Rodriguez G, Peña A (2005) Rectal prolapse following posterior sagittal anorectoplasty for anorectal malformations. J Pediatr Surg 40:192–196
Rintala RJ, Pakarinen MP (2008) Imperforate anus: long- and short-term outcome. Sem Pediatr Surg 17:79–89
Pakarinen MP, Goyal A, Koivusalo A, Baillie C, Turnock R, Rintala RJ (2006) Functional outcome in correction of perineal fistula in boys with anoplasty versus posterior sagittal anorectoplasty. Pediatr Surg Int 22:961–965
Laboure S, Besson R, Lamblin MD, Debeugny P (2000) Incontinence and constipation after low anorectal malformations in a boy. Eur J Pediatr Surg 10:23–29
Selden NR, Nixon RR, Skoog SR, Lashley DB (2006) Minimal tethered cord syndrome associated with thickening of the terminal filum. J Neurosurg 105(3 Suppl):214–218
Severino M, Manara R, Faggin R, Nogare CD, Gamba P, Midrio P (2008) Anorectal malformation and spinal dysraphism: the value of diffusion-weighted imaging in detecting associated intradural (epi)dermoid cyst. J Pediatr Surg 43:1935–1938
Gil-Vernet JM, Asensio M, Marhuenda C, Broto J, Wayar A (2001) Nineteen years’ experience with posterior sagittal anorectoplasty as a treatment for anorectal malformation. Cir Pediatr 14:108–111
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Julià, V., Tarrado, X., Prat, J. et al. Fifteen years of experience in the treatment of anorectal malformations. Pediatr Surg Int 26, 145–149 (2010). https://doi.org/10.1007/s00383-009-2497-5
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DOI: https://doi.org/10.1007/s00383-009-2497-5