The outcome of two stage repair in anorectal malformations with rectovestibular fistula.


  • Shafiq ur Rehman Sahiwal Medical College Sahiwal.
  • Yasir Makki Sahiwal Medical College Sahiwal.
  • Fareena Ishtiaq Dhakranwali Kharian.
  • Saad Fazal SIMS/Services Hospital Lahore.
  • Nauman Aziz Sahiwal Medical College Sahiwal.
  • Waleeja Shamikha Sahiwal Medical College Sahiwal.



Anorectal Malformation, Colostomy, Limited Posterior Sagittal Anorectoplasty, Rectvestibular Fistula, Two Stage Repair


Wound infection and dehiscence after recto vestibular fistula repair may affect the fecal continent mechanisms. A significant number of children with anorectal malformations have long term social, economic and psychological problems due to fecal incontinence. The role of protective colostomy should not be under estimated especially when you are treating the children from poor socioeconomic settings with compromised nutritional status. Objectives: The aim of this study was to evaluate the outcome of two stage limited posterior sagittal anorectoplasty with protective colostomy in female patients of congenital recto vestibular fistula. Study Design: Prospective study. Settings: Department of Pediatric Surgery, DHQ Teaching Hospital Sahiwal. Period: January 2016 to December 2018. Material & Methods: Thirty four girls with anorectal malformation and recto vestibular fistula underwent two stage anorectoplasty. Divided sigmoid colostomy and limited posterior sagittal anorectoplasty was performed in first stage. Six to eight weeks later stoma was closed in second stage. All the patients were evaluated for fecal continence, constipation, bowel function and complications of stoma formation, definite procedure and stoma closure. Results: The age distribution of patients at the time of surgery ranged from 9 months to 5 years (mean 27.32 months). During the first stage of repair, three patients (8.82 %) developed wound infection. Mucosal prolapse was seen in two patients (5.88%). Anal stenosis was noticed in one patient (2.94%). Seven patients (20.58%) developed peri stoma skin excoriation. Stoma prolapse was observed in three patients (8.82%). Four patients (11.76%) developed wound infection after colostomy closure. During the follow up period, constipation was reported in five patients (14.70%) and soiling in one patient (2.94%). Conclusion: Two stage correction of congenital recto vestibular fistula under the cover of colostomy is safe strategy. It is strongly recommended in a setup with limited resources and weak infrastructure. It is also useful for patients from poor socioeconomic settings.

Author Biographies

Shafiq ur Rehman, Sahiwal Medical College Sahiwal.


Assistant Professor Pediatric Surgery

Yasir Makki, Sahiwal Medical College Sahiwal.


Senior Registrar Pediatric Surgery

Fareena Ishtiaq, Dhakranwali Kharian.


WMO Basic Health Unit

Saad Fazal, SIMS/Services Hospital Lahore.


Post Graduate Traniee

Nauman Aziz, Sahiwal Medical College Sahiwal.

MBBS, M.Phil 


Waleeja Shamikha, Sahiwal Medical College Sahiwal.


Senior Registrar General Surgery