Securing the mucocutaneous anastomosis in the repair of low-anorectal anomalies

Abstract

Purpose The aim of this study was to identify the incidence of wound complications after a limited sagittal anorectoplasty for the repair of rectoperineal fistula.
Patients and methods Between January 2011 and December 2014, patients with rectoperineal fistula treated primarily by a limited sagittal anorectoplasty were  included. The patients in the study were divided into two groups according to the extent of rectal dissection and mobilization during the operation.
Results Thirty-six consecutive patients with rectoperineal fistula were included (28 girls and eight boys). Their mean age was 10 months (range 3–42 months). The overall incidence of postoperative wound dehiscence was 22.2% (eight patients). In the first group (limited rectal mobilization), there was a high incidence of wound complications (6/15 patients). Five patients were considered to have a major  dehiscence and four required a rescue colostomy. In the second group (extended rectal mobilization, 21 patients), two had minor dehiscence that were managed conservatively. The overall incidence of wound complications was significantly lower in the second group (Mann–Whitney test, P =0.04).
Conclusion Among the patients with rectoperineal fistula, extension of the dissection and mobilization of the rectum from the anterior structures (vagina in girls, and
bulpospongiosum in boys) decreases wound dehiscence following a limited sagittal anorectoplasty procedure.

Keywords: anterior ectopic anus, imperforate anus, low-anorectal anomalies, rectoperineal fistula, sagittal anorectoplasty