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Poster - 219
Primary repair of Anorectal malformations in females with vestibular or perineal fistula: A single center experience
Ubaidullah khan 1, sayed salah ud din 2, abdullah farooq 2, majid khan 2, Asım khan 2, sadam khan 2, Abdul hameed 2
1 Lady reading hospital/Farooq hospital Islamabad
2 lady reading hospital
Primary repair of Anorectal malformations in females with vestibular or perineal fistula: A single center experience
Division of Pediatric Surgery, Department of Surgery, Lady Reading Hospital.MTI
Peshawar KPK, Pakistan
Purpose: Females with recto-vestibular fistula (RVF) can be managed either by one-stage posterior sagittal anorectoplasty (PSARP) or by conventional multi-stage approach with colostomy followed by PSARP. Our aim was to define which approach, one-stage or multi-stage, is safer and more financially convenient to parents.
Methods: We collect all patients data from last 3 years which underwent the PSR; two groups of patients, primary PSR or by conventional multi-stage approach with colostomy followed by PSR. We identified all parameters which have effects on functional outcome.
Results: Of 131 total patients, 83 have primary PSARP, 30 perineum body sparing primary PSARP and 18 PSARP who have colostomy , both groups have one each local wound infection leads to minor wound dehiscence and manage conservatively. The incidence of Anorectal Stenosis was not seen in both groups following one-stage repair vs multi-stage approach. No differences were found with regards to dilation program done by mothers. At follow-up, the prevalence of soiling and constipation were similar after one-stage and multi-stage repair.
We start feeding day 1 along with local wound care and day 3 or 4 go home on educating to parents our management plan. First visit on day 7 and second day 14 of the surgery date performed.
Dilation we do not offer to all of our patients, depend on circumstances and surgeon preference.
Conclusions: In females with RVF or fistula, the PSR performed without protective colostomy have less risk of postoperative complications. However, this one-stage approach is less cost effective, less burden on hospital and excellent cosmetic results with good functional outcome.