scholarly journals Single stage Anterior Sagittal Anorectoplasty (ASARP) for Anorectal Malformations with Vestibular Fistula and Perineal Ectopic Anus in Females: A New Approach

1970 ◽  
Vol 30 (1) ◽  
pp. 37-43
Author(s):  
Ramananda Prasad Chaudhary ◽  
Bijay Thapa ◽  
Santosh Thana ◽  
Pradeep B Singh
Keyword(s):  
Bowel Function ◽  
Anorectal Malformations ◽  
Skin Incision ◽  
Single Stage ◽  
Lithotomy Position ◽  
Surgical Morbidity ◽  
Anterior Portion ◽  
Vestibular Fistula ◽  
Perineal Skin ◽  
Anterior Sagittal Anorectoplasty

Introduction: Despite a better understanding of the embryology, anatomy of anorectal malformations and of the physiology of continence, the management of children born with imperforate anus continues to be a surgical challenge and is still fraught with numerous complications and often leads to less than perfect qualitative results. Pediatric patients with recto-vestibular fistula have good prognoses in terms of bowel function when properly treated. Aim & Objective: The study was designed to assess the surgical morbidity of single stage Anterior Sagittal Anorectoplasty (ASARP). Methodology: This prospective study was carried for a period of 26 months. It included a total of 48 female patients (aged 0 - 14 years) with diagnosis of Anorectal Malformations (ARM) with vestibular fistula or perineal ectopic anus. In ASARP, Patient in lithotomy position, the anterior portion of sphincter muscles were cut through a midline perineal skin incision, rectum was separated from the vagina & then rectum was pulled through the center of these muscles. The perineal body was reconstructed and the normal appearance of perineum was achieved. Results: Short-term surgical outcome was satisfactory in all cases. No one needed colostomy. Conclusion: Single-stage ASARP is a good approach in experience hands for ARM with vestibular fistula and perineal ectopic anus in females and thereby complications and time involved in staged procedures including colostomy can be avoided. Key words: Anterior sagittal anorectoplasty, anorectal malformations, perineal ectopic anus, vestibular fistula. DOI: 10.3126/jnps.v30i1.2458 Journal of Nepal Paediatric Society Vol.30(1) 2010 37-43

scholarly journals OUTCOME OF SINGLE STAGE SPHINCTER SPARING SCARLESS ( 5S) PROCEDURE FOR RECTOVESTIBULAR FISTULA: A RETROSPECTIVE ANALYSIS

2020 ◽  
Vol 8 (11) ◽  
pp. 34-41
Author(s):  
Muhammad Riaz-Ul-Haq ◽  
◽  
Muhammad Kashif Chishti ◽  
Arsalan Raza Wasti ◽  
Mazhar Jam ◽  
...  
Keyword(s):  
Wide Spectrum ◽  
Case Series ◽  
Cost Effective ◽  
Anorectal Malformations ◽  
Single Stage ◽  
Anal Stenosis ◽  
Paediatric Surgery ◽  
Retrospective Case ◽  
Renal Anomalies ◽  
Vestibular Fistula

Background: Anorectal malformations (ARM) in girls comprise of a wide spectrum of disease ranging from imperforate anus to common cloaca, a complex malformation. Recto-vestibular fistula (RVF) is the commonest ARM in female patients. Many surgical procedures have been mentioned in the literature but trend is changing from staged to single stage procedure. Objectives: To evaluate post operative results of Single Stage Sphincter Sparing Scarless (5S) procedure for RVF. Methods: It is a retrospective case series of 24 patients with RVF who were admitted in the Department of Paediatric Surgery Jinnah Hospital Lahore and the Children Hospital and the Institute of Child Health Multan from October 2018 to September 2019, between 14 days and 4 years of age , underwent single stage sphincter sparing scarless procedure without any colostomy, anterior or posterior midline incision or division of sphincteric complex. Site of neo-anus was marked with the help of muscle stimulator and all surgeries were done under general anesthesia after meticulous gut preparation. Post operatively patients were kept nil per oral for 5 days to avoid wound contamination due to stool. Follow up was done for six months to evaluate outcome. Authors used a new name for single stage procedure. Results: Mean age was 160 days, operative time 78 minutes and hospital stay 6.8 days. 9 (37.5%) patients were diagnosed with some other associated congenital anomalies like congenital heart disease (CHD), renal anomalies, hemisacrum, syndactyly, talipes equino varus(TEV) and Downs syndrome. As a whole 13(24) presented with complication. 4(16.64%) patients presented with constipation, 3(12.5%) excoriation, 2(8.32%) anal stenosis, 2(8.32%) soiling, 1(4.16%) retraction of rectum and 1(4.16%) superficial wound infection. Patient with retraction was planned for re-do surgery, all others were managed conservatively. Conclusion: Single stage sphincter sparing scarless ( 5S) procedure for recto-vestibular fistula is safe, simple and cost effective technique. Patient suffering is minimum, as there is no colostomy, so no multiple surgeries. Complications are minimum and comparable to staged procedure.

scholarly journals The outcome of two stage repair in anorectal malformations with rectovestibular fistula.

2020 ◽  
Vol 27 (07) ◽  
pp. 1527-1532
Author(s):  
Shafiq ur Rehman ◽  
Yasir Makki ◽  
Fareena Ishtiaq ◽  
Saad Fazal ◽  
Nauman Aziz ◽  
...  
Keyword(s):  
Wound Infection ◽  
Age Distribution ◽  
Bowel Function ◽  
Anorectal Malformations ◽  
Anal Stenosis ◽  
Posterior Sagittal Anorectoplasty ◽  
Two Stage ◽  
Stoma Formation ◽  
Vestibular Fistula ◽  
Protective Colostomy

Wound infection and dehiscence after recto vestibular fistula repair may affect the fecal continent mechanisms. A significant number of children with anorectal malformations have long term social, economic and psychological problems due to fecal incontinence. The role of protective colostomy should not be under estimated especially when you are treating the children from poor socioeconomic settings with compromised nutritional status. Objectives: The aim of this study was to evaluate the outcome of two stage limited posterior sagittal anorectoplasty with protective colostomy in female patients of congenital recto vestibular fistula. Study Design: Prospective study. Settings: Department of Pediatric Surgery, DHQ Teaching Hospital Sahiwal. Period: January 2016 to December 2018. Material & Methods: Thirty four girls with anorectal malformation and recto vestibular fistula underwent two stage anorectoplasty. Divided sigmoid colostomy and limited posterior sagittal anorectoplasty was performed in first stage. Six to eight weeks later stoma was closed in second stage. All the patients were evaluated for fecal continence, constipation, bowel function and complications of stoma formation, definite procedure and stoma closure. Results: The age distribution of patients at the time of surgery ranged from 9 months to 5 years (mean 27.32 months). During the first stage of repair, three patients (8.82 %) developed wound infection. Mucosal prolapse was seen in two patients (5.88%). Anal stenosis was noticed in one patient (2.94%). Seven patients (20.58%) developed peri stoma skin excoriation. Stoma prolapse was observed in three patients (8.82%). Four patients (11.76%) developed wound infection after colostomy closure. During the follow up period, constipation was reported in five patients (14.70%) and soiling in one patient (2.94%). Conclusion: Two stage correction of congenital recto vestibular fistula under the cover of colostomy is safe strategy. It is strongly recommended in a setup with limited resources and weak infrastructure. It is also useful for patients from poor socioeconomic settings.

Recto-Vestibular Fistula: Single Stage TFARP (Trans Fistula Anorectoplasty) without Colostomy-our Experience

2016 ◽  
Vol 7 (1) ◽  
pp. 9-12
Author(s):  
Rajesh Gupta ◽  
Varun Agarwal ◽  
Archika Gupta ◽  
Anjali Gupta ◽  
Keyword(s):  
Single Stage ◽  
Vestibular Fistula

scholarly journals Extraperitoneal versus transperitoneal cesarean section: a retrospective analysis

2020 ◽  
Vol 9 (2) ◽  
pp. 567
Author(s):  
Babita P. Vaswani ◽  
Aditi Trivedi ◽  
Sriram Gopal
Keyword(s):  
Cesarean Section ◽  
Bowel Function ◽  
Nausea And Vomiting ◽  
Transperitoneal Approach ◽  
Surgical Morbidity ◽  
Post Operative Period ◽  
Early Return ◽  
Post Operative Pain ◽  
Operative Recovery ◽  
Delivery Type

Background: Cesarean section is becoming a more common delivery type worldwide. The objective of this study was to compare surgical morbidity in extraperitoneal versus transperitoneal techniques of cesarean section.Methods: A total of 60 patients was included in this study out of which 30 underwent extraperitoneal cesarean section(ECS) and 30 patients underwent transperitoneal cesarean section (TCS) and compared both the techniques with respect to nausea or vomiting intra-operatively, pain score (as measured by visual analogue scale) post operatively, return of bowel function and blood loss.Results: Intra-operative nausea and vomiting was noted in 33.34% of patients in TCS group while none of the patients in ECS group had any such complaints. No difference was noted in average blood loss between the 2 groups. Post-operative pain in ECS was 4.13 as compared to 6.86 in TCS. Return of bowel sounds in ECS group was much earlier (5.46 hours) as compared to TCS group (11.33 hours).Conclusions: We conclude that extraperitoneal technique is advantageous over transperitoneal approach. Decreased nausea and vomiting, early return of bowel function in the post-operative period, decreased post-operative pain allowing early feeding and mobilization are definite benefits of this technique. This further helps in making a relatively smoother post-operative recovery.

scholarly journals Transfistula Anorectoplasty (TFARP): Better Surgical Technique for the Management of Vestibular Fistula

2012 ◽  
Vol 4 (1) ◽  
pp. 10-14
Author(s):  
JG Khan ◽  
MA Ali ◽  
MA Yusuf ◽  
MK Islam ◽  
MA Rahaman ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Wound Infection ◽  
Operation Time ◽  
Wound Dehiscence ◽  
Cross Sectional Study ◽  
Microsoft Excel ◽  
Cross Sectional ◽  
Aesthetic Appearance ◽  
Vestibular Fistula ◽  
Perineal Skin

Background: Many approach have been tried for management of vestibular fistula, most of them have post operative complication like wound infection, wound dehiscence, more hospital stay which compromise the functional out come and aesthetic appearance of the perineum. Objective: The aim of present study was to see the effectiveness of Transfistula Anorectplasty (TFARP) Which was required minimal dissection without interruption of perineal body and perineal skin. Methodology: The cross sectional study on 43 patients with vestibular fistula were held in Dhaka Shishu Hospital from September 2008 to April 2010. Patients were operated after obtaining informed consent and standard bowel preparation. Data on demographics, operation time and postoperative complications were collected as a questionnaire and plotted on Microsoft Excel and analyzed systematically by SPSS version 17. Patients were followed up for a period of 2½ months postoperatively. Results: There is no statistical deference in patient population regarding age, geographical distribution, and clinical presentation. Mean operation time was 76.5 min for TFARP and 84.34 min for ASARP. Two (02) cases had wound infection after TFARP operation and 11 patients after ASARP operation. One patient develops partial wound dehiscence after TFARP and was healed after conservative treatment within 7 days. On the other hand 05 patients developed partial wound dehiscence and 04 patients developed complete wound disruption after ASARP which were also treated conservatively need more than 2 weeks on an average. Mean hospital stay were 6.45 days after TFARP operation and mean hospital stay were 7.87 days after ASARP operation. 20 neonates and infant who were treated by TFARP operation have good bowel movement without laxative and symmetrical anal contraction after stimulation. Conclusion: TFARP is an operation produce less morbidity and is more effective procedures and superior procedures than that of ASARP operation and give aesthetic appearance of the perineum. DOI: http://dx.doi.org/10.3329/jssmc.v4i1.11996 J Shaheed Suhrawardy Med Coll, 2012;4(1):10-14

scholarly journals ANTERIOR SAGGITAL ANORECTOPLASTY

2018 ◽  
Vol 21 (05) ◽  
pp. 845-850
Author(s):  
Naima Rasool ◽  
Mohammad Asghar Khan ◽  
Mushahid Aslam ◽  
Aqeel Safdar
Keyword(s):  
Rectal Mucosa ◽  
Anorectal Malformations ◽  
Vaginal Wall ◽  
Military Hospital ◽  
Intermediate Type ◽  
Female Children ◽  
Vestibular Fistula ◽  
Good Cosmetic ◽  
Set Protocol ◽  
The Common

… Anorectal malformation is the common congenital malformation. Ectopic anusand vestibular fistula are Intermediate types of anorectal malformations (ARM), which are themost common in female babies. Many surgical procedures have been described for the treatmentof ARM. Anterior Saggital Anorectoplasty (ASARP) is not only convenient for the anesthetist formaintenance of anesthesia but also gives better exposure of surgical structures during surgery.Objectives: To determine the technical suitability and outcome of ASARP in intermediate typesof ARM in female children. Design: This Descriptive study with prospective collection of dataaccording to a set protocol. Setting: The study was carried out at the department of PediatricSurgery, Military Hospital, Rawalpindi, Pakistan. Period: November 2010 to March 2014, overthe period of 3 years and 5 months. Patients and Methods: The data of all female patientspresenting with intermediate types of ARM and undergoing ASARP, during the study periodwere analyzed, with respect to age, type, associated anomalies, complications and cosmeticoutcome. Results: A total of 36 patients of intermediate variety underwent ASARP. Age rangedfrom 6 months to 22 years. All patients had colostomy prior to this procedure. During surgery,posterior vaginal wall tear occurred in 2 patients (5.5%). Postoperatively, 2 patients (5.5%) hadretention of urine, 2 patients (5.5%) developed wound infection with superficial disruption, analstenosis occurred in 2 patients (5.5%) and 1 patient (2.7%) had rectal mucosa prolapse. Noneof them required re_ do surgery. Cosmetic outcome was excellent in 31 patients (86.1%), while itwas satisfactory in 5 (13.8%) patients. Conclusions: Anorectoplasty through anterior approachis not only technically easy but has good cosmetic results in intermediate type of imperforateanus in female children.

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