The management of anorectal malformation with congenital vestibular fistula: a single-stage modified anterior sagittal anorectoplasty.

PURPOSE: This study aimed to evaluate the mid-term outcomes of single-stage modified anterior sagittal anorectoplasty (ASARP) for anorectal malformation with vestibular fistula.

METHOD: Twenty-six patients with congenital imperforate anus and vestibular fistula underwent single-stage modified sphincter-saving ASARP between January 2008 and December 2012. The ages of the patients at the time of operation ranged from 1 month to 5.1 years. Standard ASARP procedure was modified to avoid the incision of the external sphincter complex. Instead a potential tunnel was created through the center of external sphincter complex under the endoscopic guidance. The patients were evaluated for fecal continence and complications.

RESULT: Modified ASARP was successfully performed in all patients. The mean operation time was 52.2 ± 3.5 min (range 47-61 min). The operative blood loss was minimal. There was no operative complication. Wound infection occurred in 3 patients (3/26, 11.5%). All patients were followed up for 4.2 ± 1.5 years (range 2-6 years). No patient developed fecal incontinence. Three patients (3/26, 11.5%) had soiling once or twice per week. Four patients (4/26, 15.4%) had constipation amenable to diet management. Mucosal prolapse occurred in 1 patient (1/26, 3.8%). There was no recurrence of fistula, anal stenosis or anterior displacement of the neorectum.

CONCLUSION: Mid-term results show that single-stage modified ASARP is an effective and safe option for patients with anorectal malformation and congenital vestibular fistula.