Primary anterior sagittal anorectoplasty for rectovestibular fistula.

OBJECTIVE

To reduce the morbidity and suffering of patients with rectovestibular fistula (RVF) and to lessen the cost of the staged management protocol.

METHODS

A prospective study was carried out in the Department of Paediatric Surgery of Dhaka Shishu (Children) Hospital, Bangladesh, from January 2002 to February 2004. Twenty-three patients underwent primary anterior sagittal anorectoplasty (ASARP) for RVF, of whom 18 had congenital and five had acquired RVF. Patient age ranged from 15 days to 5 years. The diagnosis was made from history, clinical examination and ultrasonography.

RESULTS

The mean operating time was 90 minutes. There were no major perioperative complications. Three patients developed partial wound disruption in the postoperative period. All patients started oral feeding on the 4th postoperative day and the mean hospital stay was 6 days. The average bowel movements per day were 3-5 motions, without any oral therapy or enema. Two patients had occasional perineal soiling. All patients are being followed-up and the early postoperative results seem acceptable.

CONCLUSION

Primary ASARP is a good procedure for RVF as it is quick and cost-effective and requires no colostomy, laparotomy or laparoscopy.