Rectovestibular fistula: Which surgical approach is suitable? A randomized controlled trial


Submitted: 4 November 2021
Accepted: 8 March 2022
Published: 8 April 2022
Abstract views:
689


PDF:
214
HTML:
26
Appendix:
0
Video 1:
0
Video 2:
0
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

The management of a vestibular fistula is a challenge for pediatric surgeons. We compared four different operative techniques in terms of postoperative complications, continence, and cosmetic appearance. This prospective, randomized, comparative study included female children with rectovestibular fistulae who were selected from patients with Anorectal Malformations (ARMs) treated between January 2016 and July 2020. The patients were randomly divided into four groups based on the operative technique: Trans-Sphincter Anorectoplasty (TSARP), Posterior Sagittal Anorectoplasty (PSARP), Classic Anterior Sagittal Anorectoplasty (ASARP), and modified ASARP. The incidence of vestibular fistulae among all patients with ARMs was 13.4%. The total number of patients with vestibular fistula was 112, including eighty-four (75%) with rectovestibular fistulae and twenty-eight (25%) with anovestibular fistulae. Associated congenital anomalies were found in nineteen (22.6%) patients. The percentage of parents satisfied with the cosmetic appearance and continence of their children was the highest after TSARP. PSARP had the lowest incidence regarding vaginal wall injuries. TSARP is the best operative technique for handling rectovestibular fistulae and is suitable for infants and children. In the TSARP technique, the external sphincter muscle can be preserved following complete dissection of the rectum without the need for a midline skin incision. A midline skin incision is required in the modified ASARP technique.


- Levitt MA, Peña A; Anorectal Malformations (chapter 103) in Arnold G, Coran, Pediatric Surgery (7th Edition), Elsevier, pp 1289 -1309, 2012. DOI: https://doi.org/10.1016/B978-0-323-07255-7.00103-3

- Stephens FD, Smith ED, Paoul NW. Anorectal malformations in children: update 1988. March of Dimes Birth Defect Foundation. Original series, vol. 24 (4), Alan R. Liss Inc, New York, 1988.

- Bekhit E, Murphy F, Puri P, Hutson JM. The clinical features and diagnostic guidelines for identification of anorectal malformations. In Holschneider AM, Hutson JM (eds). Anorectal malformations in children embryology, diagnosis, surgical treatment, follow up. 2006, vol 9, Springer-Verlag Berlin Heidelberg Publisher, pp 185-186.

- Holschneider A, Hutson J, Peña A, et al. Preliminary report on the International Conference for the Development of Standards for the Treatment of Anorectal Malformations. J Pediatr Surg 2005;40:1521-6. DOI: https://doi.org/10.1016/j.jpedsurg.2005.08.002

- Kamal JS. Anal transposition (trans-sphincteric ano-rectoplasty) for recto-vestibular fistula. Saudi J Health Sci 2012;1:89-91. DOI: https://doi.org/10.4103/2278-0521.100959

- Khan JG, Ali MA, Yusuf MA, et al. Transfistula anorectoplasty (TFARP): Better surgical technique for the management of vestibular fistula. J Shaheed Suhrawardy Med Coll 2012;4:10-4. DOI: https://doi.org/10.3329/jssmc.v4i1.11996

- Harjai MM, Sethi N, Chandra N. Anterior sagittal anorectoplasty: An alternative to posterior approach in management of congenital vestibular fistula. Afr J Paediatr Surg 2013;10:78-82. DOI: https://doi.org/10.4103/0189-6725.115027

- Demirbilek S, Atayurt HF. Anal transposition without colostomy: functional results and complications. Pediatr Surg Int 1999;15:221-3. DOI: https://doi.org/10.1007/s003830050560

- Caroline F, Aronson DC. Anterior or posterior anorectoplasty without colostomy for low type anorectal malformation: how to get a better outcome? J Pediatr Surg 2010;45:1505-8. DOI: https://doi.org/10.1016/j.jpedsurg.2010.02.042

- Mitul AR, Ferdous KM, Shahjahan M, et al. Trans-fistula anorectoplasty (TFARP): Our experience in the management of Anorectovestibular fistula in neonates. J Neonat Surg 2012;1:36.

- Menon P, Rao KL. Primary anorectoplasty in females with common anorectal malformations without colostomy. J Pediatr Surg 2007;42:1103-6. DOI: https://doi.org/10.1016/j.jpedsurg.2007.01.056

- Elsawaf MI, Hashish MS. Anterior sagittal anorectoplasty with external sphincter preservation for the treatment of recto-vestibular fistula: A new approach. J Indian Assoc Pediatr Surg 2018;23:4-9. DOI: https://doi.org/10.4103/jiaps.JIAPS_2_17

Abdelmohsen, sarah ., Osman, M. A., Mostafa, H. A., Fathy, M. ., Ibrahim, I. A., Mostafa, M. M., Eltayeb, A. A., & Abdul Raheem, O. A. (2022). Rectovestibular fistula: Which surgical approach is suitable? A randomized controlled trial. La Pediatria Medica E Chirurgica, 44(1). https://doi.org/10.4081/pmc.2022.278

Downloads

Download data is not yet available.

Citations