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TÜRKÇE
Oral Presentation - 142
Transsphincteric anorectoplasty and perineal body-sparing surgical approach (TSARP) for anal atresia with rectovestibular fistula
Berat Dilek Demirel, Pelin Nur Cinel, Başak Dağdemir Ezber, Sertaç Hancıoğlu, Beytullah Yağız
Ondokuz Mayıs University, Faculty of Medicine, Department of Pediatric Surgery, Samsun, Turkey
Aim: To present the functional results of transsphincteric anorectoplasty and perineal body sparing surgery (TSARP) procedure in patients with anal atresia and rectovestibular fistula.
Method: Patients received TSARP for rectovestibular fistula between 2018 and 2024 were included in the study. Age, perioperative complications, presence of colostomy, calibration procedure, continence and cosmetic results were evaluated retrospectively. Postoperative functional evaluation was performed according to Krickenbeck classification.
Results: During the study period, 26 patients underwent TSARP. Primary surgery without colostomy was performed in 16 patients (61,5%), 10 (38.5%) patients received colostomy before corrective surgery. The median age at surgery was 40 days (range 2 days–7 months); 71.5 days for patients with colostomy and 30 days for patients without colostomy. Posterior wall of the vagina was injured in 2 patients during dissection and was repaired uneventfully. Patients with colostomy were started on enteral nutrition at the third postoperative hour, while those without colostomy started on the third postoperative day. Wound infection developped in 2 patients without colostomy; one recovered by nonsurgical measures while the other underwent colostomy. Among the 18 patients over three years of age, 15 had voluntary bowel control (Krickenbeck classification). Four patients had Grade 1 constipation and 3 patients had Grade 2 constipation while no soiling was observed.
Conclusion: The TSARP approach enables complete rectal dissection while preserving the sphincter complex and perineal body which reduces wound site complications and allows corective surgery without colostomy. Satisfactory functional continence and cosmetic results are attributed to the preservation of sphincter integrity and perineal anatomy.