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Abstract
Background: Anorectal malformations are birth deformities in which the anus is absent or deformed. It affects both males and females and has a prevalence of one in 5000 live births. Recto vestibular fistula is the most common type of female congenital anorectal abnormality that presents to the pediatric surgeon in early life for surgical repair. In this case, the rectum terminates with a fistula to the vestibule. Anatomically, the main character of this deformity is common wall between rectum and vagina. On correct management of rectovestibular fistula, it shows excellent prognosis with respect to function. From ancient times, there are multiple operative techniques described in literature for the management and treatment of vestibular fistula which including posterior sphincter called posterior sagittal anorectoplasty (PSARP), and anterior to sphincter called anterior sagittal anorectoplasty (ASARP). The Posterior Sagittal (PSARP) or Anterior Sagittal (ASARP) ano-recto plasty are the most commonly performed procedures in the treatment of vestibular fistulas. This study aimed to compare the results of this alternative approach of ASARP to a well-established procedure of PSARP in the therapy of vestibular fistula.
Methods & Materials: A Randomized controlled trial registered with TCTR with trial number (TCTR20250313005) is conducted at Department of Paediatric Surgery, The Children’s Hospital and The University of Child Health, Ferozpur Road, Lahore from January 2023 to January 2024. Non-Probability purposive sampling was taken. Allocation of treatment was ensured using balloting method.
Results: Group A and group B are comparable with respect to age, weight, duration of surgery and hospital stay. Group A has 56.7% complication rate while Group B has 50% complications. Group A has 6.7% procedural injuries, 33.3% anal stenosis and mucosal prolapse in 10% while group B has 10%, 30% and 6.7% respectively. On TENS application, ASARP group has good contractions all around in 80% of patients and weak on one side in 20% while PSARP group has good contractions all around in 80% of patients, weak on one side in 16.7% of patients while weak all around in 3.3% patients. With respect to wound infection, disruption and retraction, group A has 6.7%, 10% and 6.7%, respectively while group B has 10%, 13.3% and 0% respectively.
Conclusion: ASARP and PSARP are two well established techniques in the management of vestibular fistula. Many studies determine ASARP as less time consuming and with less complications, but it is not proven statistically. In this study, we found both the techniques comparable with respect to early and late complications and functional ability of the patients. Further study with large sample size is required to establish a significant difference between the two techniques.