ANTERIOR SAGGITAL ANORECTOPLASTY

THE TREATMENT OF ANORECTAL MALFORMATIONS IN FEMALE CHILDREN

Abstract

… Anorectal malformation is the common congenital malformation. Ectopic anus
and vestibular fistula are Intermediate types of anorectal malformations (ARM), which are the
most common in female babies. Many surgical procedures have been described for the treatment
of ARM. Anterior Saggital Anorectoplasty (ASARP) is not only convenient for the anesthetist for
maintenance of anesthesia but also gives better exposure of surgical structures during surgery.
Objectives: To determine the technical suitability and outcome of ASARP in intermediate types
of ARM in female children. Design: This Descriptive study with prospective collection of data
according to a set protocol. Setting: The study was carried out at the department of Pediatric
Surgery, Military Hospital, Rawalpindi, Pakistan. Period: November 2010 to March 2014, over
the period of 3 years and 5 months. Patients and Methods: The data of all female patients
presenting with intermediate types of ARM and undergoing ASARP, during the study period
were analyzed, with respect to age, type, associated anomalies, complications and cosmetic
outcome. Results: A total of 36 patients of intermediate variety underwent ASARP. Age ranged
from 6 months to 22 years. All patients had colostomy prior to this procedure. During surgery,
posterior vaginal wall tear occurred in 2 patients (5.5%). Postoperatively, 2 patients (5.5%) had
retention of urine, 2 patients (5.5%) developed wound infection with superficial disruption, anal
stenosis occurred in 2 patients (5.5%) and 1 patient (2.7%) had rectal mucosa prolapse. None
of them required re_ do surgery. Cosmetic outcome was excellent in 31 patients (86.1%), while it
was satisfactory in 5 (13.8%) patients. Conclusions: Anorectoplasty through anterior approach
is not only technically easy but has good cosmetic results in intermediate type of imperforate
anus in female children.