WOFAPS 2025 8th World Congress of Pediatric Surgery

Nahla Kechiche, Nouha Boukhrissa, Rachida Lamiri, Mongi Mekki, Lassaad Sahnoun

Department of Pediatric Surgery, Monastir University Hospital, Tunisia

Introduction:
Rectovestibular fistula represent the most frequent low anorectal malformations in girls. The standard surgical approach popularized by Peña posterior sagittal anorectoplasty (PSARP)has long been considered the gold standard. However, the anterior sagittal approach has emerged as a less invasive alternative, allowing direct access to the rectovaginal space while minimizing sphincter disruption.

Purpose:
This study aims to report a single-center, 16-year experience with ASARP in female patients with rectovestibular fistula, and to evaluate long-term functional and cosmetic outcomes.

Methods:
We conducted a retrospective review of female patients with rectovestibular fistula treated with ASARP. The choice of approach was based on its limited perineal incision, minimal external sphincter division, and improved exposure of the rectum and vagina.

Results :

Fifty-two patients were included. Median age at diagnosis was 36 days; 71 % were recognised neonatally. AARP technique as a one-stage operation without preliminary colostomy was performed at a mean age of 6 months; mean operative time was 105 min, compared with the 120–150 min usually reported for PSARP. Dissection proved difficult in 7 patients (13 %); vaginal and rectal injuries occurred in 5 (9.6 %) and 2 (3.8 %). Post‑operative infection developed in 13 patients (25 %), anastomotic leakage in 10 (19 %) and re‑operation was required in 4 (7.7 %). Continence assessed in 37 children aged ≥ 3 years was normal in 22 (59 %), with chronic constipation in 7 (18.9 %) and occasional soiling in 8 (21.6 %). Mean hospital stay was 5.4 days and 93 % of parents rated perineal appearance good or excellent.

Conclusion :

ASARP offers a safe and effective alternative to PSARP for the correction of rectovestibular fistula. It is associated with reduced operative time, favorable functional outcomes, and excellent cosmetic results. These findings support the use of ASARP as a preferred approach in selected cases of low anorectal malformations in girls.