Experience of Transfistula (TFARP) Repair for Congenital Recto-Vestibular Fistula

Abstract

Background: The objective of this study is to assess the feasibility of aprimary transfistula anorectoplasty (TFARP) in congenital recto-vestibular fistula without a covering colostomy in the north of Iraq. Patients and Methods: Female patients having imperforate anus with congenital rectovestibular fistula presenting to pediatric surgical centres in the north of Iraq (Mosul & Erbil) between 1995 to 2011 were reviewed in a nonrandomized manner, after excluding those with pouch colon, rectovaginal fistula and patients with colostomy. All cases underwent one stage primary (TFARP) anorectoplasty at age between 1-30 months, after on table rectal irrigation with normal saline&povidoneIodine. They were kept nil by mouth until 24 hours postoperatively. Postoperative regular anal dilatation were commenced after 2 weeks of operation when needed. The results were evaluated for need of bowel preparation, duration of surgery,, cosmetic appearance, commencement of feed and hospital stay,postoperative results. Patients were also followed up for assessment of continence and anal dilatation. Results: A total of 73 patients with an age range of 1-30 months (median, 15.5months) were studied after excluding one with pouch colon and another with rectovaginal fistula. Operative time ranged from 60 to 80 min (median, 70 min). Bowel preparation was not done before operation. Oral feeding was started after 24h in all patients and average duration of hospital stay was 3 days. Parents of 8 cases (10.9%) were related, however in spite of that, a positive family history was found in only one case (1.3%). Follow-up ranged from (1 - 14) years (median, 7.5 years). There were 2 wound infections. Wound dehiscence was noted in one case (1.4%); no recurrence of fistula was noted. At 3 months postoperative, most patients had 1 - 3 stools per day with no episodes of soiling. Twelve (16.4%) patients had grade I-II constipation and 3 cases (4%) had partial anal mucosal prolapse. Conclusions: One-stage Primary Tranfistula anorectoplasty in imperforate anus with rectovestibular fistula can be effectively performed with good cosmetic appearance and functional result.