Perineal body-sparing transsphincteric anorectoplasty (TSARP) for rectovestibular fistula: Mid-term functional outcomes from a single center.

PURPOSE: This study aimed to evaluate the mid-term functional and cosmetic outcomes of perineal body-sparing trans-sphincteric anorectoplasty (TSARP) in patients with anal atresia and rectovestibular fistula.

METHODS

Patients with anal atresia and rectovestibular fistula who underwent perineal body-sparing TSARP between 2018 and 2024 were retrospectively reviewed. All procedures were performed by a single pediatric surgeon. Demographic data, presence of colostomy, perioperative complications, postoperative first-feeding time, and functional outcomes were recorded. Functional outcomes in patients were assessed using the Krickenbeck classification.

RESULTS

Twenty-six patients underwent perineal body-sparing TSARP. One-stage repair was performed in 16 patients (61.5%), whereas 10 (38.5%) had a protective colostomy. The median age at operation was 40 days (range 2 days-7 months). Posterior vaginal wall injury occurred in two patients and was repaired uneventfully. Two patients developed wound infection that resolved with local wound care. The mean follow-up duration was 3.25 years. Among 18 patients older than 3 years old, voluntary bowel control was present in 15 patients (83.3%). Constipation occurred in seven patients, and no patient developed soiling.

CONCLUSION

Perineal body-sparing TSARP appears to be a safe and effective technique for rectovestibular fistula, providing low complication rates with satisfactory functional and cosmetic outcomes.