Single-stage correction of imperforate anus with a rectourethral or a rectovestibula fistula by semi-posterior sagittal anorectoplasty

Abstract

The aim of this study was to evaluate the clinical advantages of a single-stage correction of imperforate anus with a rectourethral or a rectovestibula fistula in neonates by a semi-posterior sagittal anorectoplasty (PSARP). The medical records of 38 neonates (5 females and 33 males) who had imperforate anus with a rectourethral or a rectovestibula fistula were reviewed and analyzed in Children’s Hospital of Fudan University between January 2004 and July 2007. All patients had an anorectal malformation but without obvious sacral dysplasia. The first group had a single-stage PSARP without a colostomy. All neonates were full-term without severe cardiac, renal anomalies or severe abdominal distension. The second group had a staged Peña procedure; the neonates were not suitable for a single-stage PSARP because of severe abdominal distention or cardiac, renal anomalies. A transverse colostomy was performed, followed 3–6 months later by the Peña procedure, and colostomy closure 2 months thereafter. The congenital anomalies, fetal age, birth weight, time and age of the definitive operation, complications, length of hospital stay, cost, and postoperative bowel movements were analyzed between these two groups. Among the 38 patients, 22 had a single-stage definitive operation and 16 had a staged pull-through procedure. There were significant differences in congenital anomalies between the two groups (P = 0.0314), but no statistically significant differences between the fetal ages, weight at birth, and time and age at the time of the definitive operation (P > 0.05). One patient in the first group had intestinal obstruction and intestinal perforation. For the second group, early complications were related to the colostomy. At after 3 years postoperatively, 9 patients in the first group and 12 patients in the second group were followed-up and all had positive voluntary bowel movements. There were no statistically significant differences in soiling and constipation grades between the two groups. The total length of hospital stay was 12.06 ± 0.85 and 33.85 ± 0.94 days and the cost was 10,681.1 ± 1,759.5 and 27,355.9 ± 1,952.0 RMB for the first and second groups, respectively. There was a statistically significant difference in the total length of hospital stay and cost between the two groups (P < 0.0001); however, there were no statistically significant differences in the length of hospital stay and cost during the definitive operation between the two groups (P > 0.05). This retrospective study shows that it is feasible for correction of imperforate anus with a rectourethral or a rectovestibula fistula in neonates using a modified PSARP without a colostomy.