A prospective single-center cohort study on a modification of the posterior sagittal anorectoplasty technique for vestibular fistula in females

Background: The posterior sagittal anorectoplasty (PSARP) approach is used to repair the anorectal malformations (ARMs) with rectovestibular fistula. The incision extends from the coccyx posteriorly to the vestibule anteriorly cutting the perineal body (PB) skin. Dehiscence of the PB can have several long-term adverse events. Aim: In this study, we modify the PSARP approach by leaving the PB intact and making the incision just limited to the anoplasty area. Patients and Methods: We operated on 20 patients with a rectovestibular fistula using this modified technique in a single center between February 2023 to January 2024. The incision is limited to the anoplasty area with a final result of the skin incision is completely incorporated into the anoplasty. We assessed the mean operative time, intraoperative complications, postoperative complications, duration of hospital stay, scar cosmesis, and assessment of the continence for patients aged over three years old. Results: Five patients were stooling via a colostomy and 15 patients via a fistula. Patients’ ages ranged between 3 and 18 months. The mean operative time was 88.9 minutes. All cases healed with excellent cosmetic results. Intraoperatively, one case had a vaginal injury. Postoperatively, one case developed partial rectal mucosal prolapse. All patients were too young to be evaluated for bowel control.Conclusion: This technique preserves all the benefits of the traditional PSARP and has the potential to eliminate PB dehiscence and its long-term complications. We believe that with a larger number of patients and longer follow-up periods, this technique will be a common approach.