Outcomes of the Surgical Treatment of Infants with Imperforate Anus and Vestibular Fistula without Primary Colostomy
Keywords:
Imperforate anus, Vestibular fistula, Single-stage repair, Without protective colostomy, OutcomeAbstract
Introduction: Female infants with imperforate anus with vestibular fistula can be surgically treated with either one - stage repair without colostomy or conventional multi-stage repair after primarily prospective colostomy. One stage approach is more preferable in the present period.
Objective: The aim of this study was to access the outcomes of a single-stage repair without colostomy in female infants with imperforate anus and vestibular fistula.
Materials and Methods: Medical records of the patients who were diagnosed imperforate anus with vestibular fistula and treated with a single-stage repair without colostomy during 2012 to 2016 at Queen Sirikit National Institute of Child Health were reviewed. Demographic data, operative procedures and outcomes of treatment were evaluated.
Results: During the study period, 34 female infants with imperforate anus and vestibular fistula underwent a single-stage repair without protective colostomy at our institute. They were classified as anovestibular fistula (AVF) in 15 cases (44.1%) and rectovestibular fistula (RVF) in 19 cases (55.9%). Most of the patients were term and normal birthweight infants. Cardiovascular defects were the most common associated anomalies. Infants with AVF were surgically treated by cut-back anoplasty (5 cases), anal transfer (4 cases) and anterior sagittal anorectoplasty or ASARP (6 cases). Infants with RVF underwent only anal transfer (5 cases) and ASARP (14 cases). Wound infection and wound dehiscence were the common postoperative complications which were noted in approximately 15% and 25%, respectively. Anorectal retraction and recurrent fistula occurred in one case, each. Both cases required redooperation for correction several weeks later without protective colostomy. One-third of the patients had constipation with more often in RVF than AVF. Constipation was managed by toilet training, laxative and occasional enema. There was no mortality in all of the patients.
Conclusion: Female infants with imperforate anus and vestibular fistula could be safety treated by a singlestage repair without protective colostomy. From the present study, even major complications occurred and required redo-operation, the patients could be successfully corrected without diverted colostomy.
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