Surgical treatment of isolated and associated congenital rectoperinetic fistura in children
Keywords:congenital anorectal malformation, rectoperineal fistula, associated malformations, surgical tactics, anterior sagittal anorectoplasty, posterior sagittal anorectoplasty, children, girls, boys
Congenital anorectal malformations (CARM) include a number of different options that differ in their anatomical and functional features. One of these options is rectoperineal fistula (RPF).
Purpose - to evaluate the results of surgical treatment of congenital RPF in children, using a differentiated approach to diagnosis and methods of correction of its isolated and associated forms.
Materials and methods. The study included 28 patients with RPF, which accounted for 18.2% of all treated CARM: boys - 18 (64.3%), girls - 10 (35.7%). Verification of the main disease and associated developmental defects was carried out on the basis of clinical and instrumental research methods. Isolated anorectal malformation (ARM) was diagnosed in 15 (53.6%) children, 8 (53.3%) boys, 7 (46.7%) girls, and associated - in 13 (46.4%) patients, 10 (76.9%) boys, 3 (23.1%) girls.
Results. One-stage surgical treatment was performed in 2 (7.1%) patients with associated ARM. Staged surgical treatment, with colostomy removal and anorectoplasty, was performed in 26 (92.9%) children. Anterosagittal anorectoplasty was performed in 14/26 (53.8%) of children: 10 (71.4%) boys, 4 (28.6%) girls; minimal posterior sagittal - in 26.9% (7/26): 2 (28.6%) boys, 5 (71.4%) girls; posterior sagittal according to Pen, applied in 19, 2% (5/26), and only in boys. The third stage of treatment included closing the stoma from local access. Removal of the colostomy and formation of an end-to-end anastomosis was performed in 25 (96.1%) patients without complications.
Conclusions. The use of a differentiated approach to diagnostics and methods of anorectoplasty, as well as the use of a complex of rehabilitation treatment for isolated and associated forms of ARM, allowed to obtain good results - in 81.5% and satisfactory results - in 18.5% of children. The choice of tactics for surgical correction of RPF should be individual for each patient, considering the anatomical and functional features of the defect, gender and the presence of a certain range of associated malformations.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies.
No conflict of interests was declared by the authors.
Dzham O, Sliepov O. (2020). Relevant problems of classification of anorectal malformations in children in modern conditions (literature review). Paediatric Surgery. Ukraine. 3 (68): 41-48. https://doi.org/10.15574/PS.2020.68.41
Dzham OP, Sliepov OK, Soroka VP. (2022). Choice of tactics surgical tretment of congenital anorectal malformation with rectovestibular fistula, in girls. Paediatric Surgery (Ukraine). 3 (76): 86-91. https://doi.org/10.15574/PS.2022.76.86
Halleran DR, Coyle D, Kulaylat AN, Ahmadd H et al. (2022). The cutback revisited - The posterior rectal advancement anoplasty for certain anorectal malformations with rectoperineal fistula. J. Pediatr. Surg. 57: 85-88. https://doi.org/10.1016/j.jpedsurg.2021.12.014; PMid:35012765
Holschneider AM, Hutson JM. (2006). Anorectal Malformations in Children. Embryology, Diagnosis, Surgical Treatment, Followup. Springer-Verlag Berlin Heidelberg: 480.
Irfan A, Hu A, Martin LY, Jelin EB, Garcia AV et al. (2021). Comparing 30-day outcomes between early versus delayed repair of anorectal malformations with perineal or rectovestibular fistulas: An analysis of the ACS NSQIP-Pediatric database. J. Pediatr. Surg. 56: 979-983. https://doi.org/10.1016/j.jpedsurg.2020.09.002; PMid:33023749
Kumar B, Kandpal DK, Sharma SB, Agrawal LD et al. (2008). Jhamariya Single-stage repair of vestibular and perineal fistulae without colostomy. J. Pediatr. Surg. 43: 1848-1852. https://doi.org/10.1016/j.jpedsurg.2008.03.047; PMid:18926219
Lai K, Hargis-Villanueva A, Velazco CS, Weidler EM et al. (2023). Early postoperative feeding in single-stage repair of anorectal malformation with vestibular or perineal fistula is not associated with increased wound complications. J. Pediatr. Surg. 58: 467-470. https://doi.org/10.1016/j.jpedsurg.2022.07.009; PMid:35934522
Levitt MA, Pena A. (2007). Anorectal malformations. Orphanet J. of Rare Diseases. 2(3): 1-13. https://doi.org/10.1186/1750-1172-2-33; PMid:17651510 PMCid:PMC1971061
Nah SA, Ong CC, Lakshmi NK, Yap TL et al. (2012). Anomalies associated with anorectal malformations according to the Krickenbeck anatomic classification. J. Pediatr. Surg. 47: 2273-2278. https://doi.org/10.1016/j.jpedsurg.2012.09.017; PMid:23217888
Negm MA. (2020). Short-term outcome of one-stage sphincter-saving anterior sagittal anorectoplasty in vestibular and perineal fistulae in female infants. Egept J Surg. 39 (1): 199-205. https://doi.org/10.4103/ejs.ejs_171_19
Pettersson Borg H. (2013). Bladder and bowel dysfunction in children with anorectal malformations. Institute of Clinical Sciences at Sahlgrenska Academy University of Gothenburg, Sweden: 68.
Qazi1 SH, Faruque AV, Khan MA, Saleem U. (2016). Functional Outcome of Anorectal Malformations and Associated Anomalies in Era of Krickenbeck Classification. J. of the College of Physicians and Surgeons Pakistan. 26 (3): 204-207.
Rassol N, Khan MA, Aslan M, Safdar A et al. (2014). Anterior saggital anorectoplasty; the treatment of anorectal malformations in female children. Professional Med. J. 21 (5): 845-850. https://doi.org/10.29309/TPMJ/2014.21.05.2521
Rentea RM, Halleran DR, Vilanova-Sanchez A, Lane VA, Reck CA et al. (2019). Diagnosis and management of a remnant of the original fistula (ROOF) in males following surgery for anorectal malformations. J. Pediatr. Surg. 54: 1988-1992. https://doi.org/10.1016/j.jpedsurg.2019.02.006; PMid:30879755
Rocourt DV, Kulaylat AS, Kulaylat AN, Leung S et al. (2019). Primary Posterior Sagittal Anorectoplasty Outcomes for Rectovestibular and Perineal Fistulas Using an Accelerated Pathway: a Single Institution Study. J. Pediatr. Surg. 54: 1178-1781. https://doi.org/10.1016/j.jpedsurg.2019.05.020; PMid:31204055
Sanal M, Renz O, Hechenleitner P, Häussler B. (2017). Preoperative evaluation, surgical strategy and long-term outcome of anorectal malformations in newborn period: Single center experience. Res. Rev. Insights. 1: 1-3. https://doi.org/10.15761/RRI.1000103
Stephens FD, Smith ED, Pauol NW. (1988). Anorectal malformations in children; update. March Dimes Birth Defect Foundation. Original series. New York. 24 (4): 1352-1361.
Zamir N. (2020). The early outcome of primary anterior sagittal approach for low anorectal malformations in female patients. Pak J Med Sci. 36 (3): 456-460. https://doi.org/10.12669/pjms.36.3.1503
Copyright (c) 2023 Paediatric Surgery (Ukraine)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The policy of the Journal “PAEDIATRIC SURGERY. UKRAINE” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license(СС BY-NC).
Authors transfer the copyright to the Journal “PAEDIATRIC SURGERY.UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.