Initial outcomes of single-stage operation through modified posterior sagittal anoplasty approach for intermediate anorectal malformations in the neonate

Abstract

Abstract Background:Three-stage posterior sagittal anorectoplasty (PSARP) is the standard technique for treated of high and intermediate anorectal malformations and is widely used worldwide. Single-stage modified PSARP approach for intermediate anorectal malformations has been reported. The study aims to describe the surgical technique and initial outcomes of single-stage operation through a modified PSARP approach preserving the external sphincter intact for intermediate anorectal malformations in neonates. Patients and Method: A prospective cohort study was done on twenty-five patients with intermediate anorectal malformations operated on by single-stage operation through a modified PSARP approach preserving the external sphincter intact from May 2021 to June 2022. Variables included age of operation, associated anomalies, type of fistula, duration of hospital stay, complications, and initial functional outcomes. Surgical technique: Skin incision behind the rectum, dissected and exposed the rectal pouch, preserved the sphincter complex intact and dissected the rectal pouch from the posterior wall of the urethra or vagina. Suture the urethral fistula (if any). Use muscle stimulation to define the sphincter center, make a tunnel through the sphincter center, and the rectum through the sphincter complex center for anorectoplasty. Results: 25 patients including 22 boys and 3 girls, the mean age at operation were 25.3 ± 6.0 hours (range, 20 - 48 hours). The mean operative time was 49.4 ± 9.9 minutes (range 30–75 minutes), and the mean hospital stay was 6.7 ± 1.2 days (from 5 to 9 days). There were no early postoperative complications. Follow-up from 2 to 15 months, all patients have 1-6 bowel movements/day. There were 2 patients with rectal pouch syndrome and redo-operated colon pull-through by laparoscopy. Rectal mucosal prolapse occurred in 3 patients, No patient has anal stenosis or constipation. Conclusion: Single-stage operation through a modified PSARP approach preserving the external sphincter intactfor intermediate anorectal malformations in the neonate is feasible, safe, and effective.