Surgical treatment of congenital anorectal malformation with rectovesical fistula in boys
DOI:
https://doi.org/10.15574/PS.2024.82.62Keywords:
congenital anorectal malformation, rectovesical fistula, congenital pouch colon, associated malformations, surgical tactics, posterior sagittal anorectoplasty, longitudinal coloplasty, narrowing coloplasty, stapled coloplasty, children, boysAbstract
Congenital rectovesical fistula (RVF) is the most complex variant of anorectal malformations (ARM) in boys, characterized by a fistula connecting the rectum with the bladder.
Purpose - to evaluate the results of surgical correction of RVF in children, using a differentiated approach to the diagnosis of this defect, depending on the anatomical options, the clinical course of associated defects, and, based on this, to develop the main tactical requirements for the treatment of this complex congenital ARM in children.
Materials and methods. The study included 9 boys: 7 - RVF without pouch colon and 2 - RVF with congenital pouch colon, which accounted for 5.8% of all treated anorectal anomalies (n=154).
Results. In patients with RVF without pouch colon: a double-stem disconnecting colostomy was performed in 3 (33.3%) and a double-stem loop colostomy in 4 (44.4%) boys. In children with RVF and pouch colon: a longitudinal, narrowing, stapler coloplasty of the large intestinal "pouch" was performed, with removal of the terminal stoma (n=1); formation of a double-stem disconnecting stoma without separation of the RVF, and at the II stage - elimination of the RVF, removal of the large intestinal «bag» and preservation of the ileostomy - as a permanent, lifelong stoma (n=1). In 7 (100%) patients with RVF without pouch colon at the II stage, abdomino-perineal posterosagittal anorectoplasty with separation of RVF was performed (n=5). At the III stage, 5 patients with RVF without a pouch colon underwent local access stoma closure. At the stages of primary correction of RVF 55.6% (n=5) of children had coloproctological complications.
Conclusions. The use of a differentiated approach to diagnosis and methods of anorectoplasty, as well as the use of a complex of rehabilitation treatment in patients with RVF without a pouch colon made it possible to obtain good results in 50% and satisfactory results in 50% of children. Congenital pouch colon - a significant expansion of part or the entire colon already in the fetus, makes it possible to suspect and diagnose this defect in the prenatal period, and to carry out delivery and surgical correction in a specialized perinatal center.
The research was carried out in accordance with the principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the work. Informed consent of the patients was obtained for the research.
No conflict of interests was declared by the author.
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