Functional Outcomes of Anterior Sagittal Anorectoplasty Repair for Rectovestibular Fistula: An Integrated Clinical and MRI-based Assessment: Initial Findings.

BACKGROUND/PURPOSE: This study aimed to assess the functional outcomes of anterior sagittal anorectoplasty for rectovestibular fistula using an integrated Rintala clinical continence score and MRI-based assessment.

METHODS

Between October 2022 and April 2024, female patients with rectovestibular fistula who underwent anterior sagittal anorectoplasty were investigated. The patients were at least 4 years old, and cases with spinal cord anomalies or sacral dysplasia were excluded. MRI was performed and linked to the Rintala clinical continence score. The MRI parameters assessed were anorectal angle, striated muscle surrounding the neorectum, centrality of the neorectum, pubococcygeal (PC) distance, and pelvic hiatal distance.

RESULTS

Twelve patients (mean age 68.6 months, range 54-108) were enrolled in this study. The findings revealed that the anorectal angle was strongly correlated with the total Rintala score (Spearman rank = -0.831, p < 0.001), social problems (Spearman rank = -0.879, p < 0.001), and accidents (Spearman rank = -0.790, p = 0.002). Additionally, the hiatal/pubococcygeal ratio was correlated with the total Rintala score (Spearman rank = -0.627, p = 0.029), the ability to hold back defecation (Spearman rank = -0.725, p = 0.008), soiling (Spearman rank = -0.733, p = 0.007), and accidents (Spearman rank = -0.778, p = 0.002). Furthermore, deficient striated muscle significantly correlated with the total Rintala score (Spearman rank = -0.652, p = 0.022) and accidents (Spearman rank = -0.827, p < 0.001). Non-centralized neorectum correlated with the urge to defecate (Spearman rank = -0.674, p = 0.016) and soiling (Spearman rank = -0.548, p = 0.065). Additionally, the presence of fat tissue between the anorectum and the muscle was correlated with constipation (Spearman rank = -0.529, p = 0.077).

CONCLUSIONS

The anatomical findings following anterior sagittal anorectoplasty for repairing the rectovestibular fistula are crucial in determining the functional outcome. To enhance functional outcomes, meticulous surgical techniques are essential to achieve a more acute anorectal angle, maintain the integrity of the striated muscle sphincter, align the neorectum centrally, and ensure an appropriate size of the pelvic hiatus.

LEVEL OF EVIDENCE: Level IV.