Primary Vs. Staged Repair for Low Anorectal Malformation: Outcome of Two Institutions Experience

Abstract Introduction: Anorectal malformations (ARM) constitute one of the frequent congenital anomalies which are encountered in pediatric surgery in 1 in 5000 births. The defect affects the normal positioning of the anus, and a corrective surgical procedure is required for repositioning. Rectovestibular fistula is the most common form of ARM that is found in female infants. Posterior sagittal anorectoplasty (PSARP) without colostomy (single-stage) and Posterior sagittal anorectoplasty with colostomy (three-stages) has often been compared as the most feasible interventions to treat both rectovestibular and rectoperineal fistulae. The objective of this study was to assess the result of posterior anorectoplasty with or without diverting colostomy in patients with rectoperineal or rectovestibular fistulae. Methodology: A retrospective cohort study was undertaken to examine the post-operative outcomes of single-stage and three-stages PSARP on infants with rectovestibular and rectoperineal fistulae in Riyadh and Jeddah regions of Saudi Arabia. After ethical approvals from King Abdullah International Medical Research Centre, the study reviewed patient files from National Guard hospitals from the two regions. Results: Out of the 50 patients studied, 80% were females, while 20% were males. The most typical type of fistula was rectovestibular, which accounted for 54%, while rectoperineal accounted for 46%. PSARP without colostomy (single-stage) was the most common intervention. Major complications reported after the operations were constipation (44%), soiling (10%), wound infection (6%) and dehiscence (6%). Conclusion: The one-stage PSARP without colostomy has been identified as the feasible, safe, cost-effective surgical procedure to be used on ARM infants.