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