Posterior rectal advancement with fistula preservation in patients with anorectal malformation. A multicenter study.

C Ramirez Amorós, C Gine Prades, M San Basilio, M Fanjul, A Sánchez Galán, M J Martínez Urrutia, A Vilanova-Sanchez
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Abstract

Background: Anorectal malformations (ARM) with rectoperineal fistula are mainly repaired with a posterior sagittal anorectoplasty (PSARP), which can be challenging given the proximity of the fistula to the vagina and urethra. The posterior rectal advancement anoplasty (PRAA), preserves the anterior wall of the fistula without leaving an anterior or a posterior sagittal incision. It is indicated for selected cases of ARM with rectoperineal fistula in which the anterior aspect of the fistula is partially surrounded by sphincter complex.

Methods: Multicentre and retrospective study of patients with rectoperineal fistula treated with PRAA. We analysed gender, associated malformations, age, operative time, short and long-term results, and complications.

Results: 18 patients aged 93.5 (1.75-312) days underwent PRAA. Surgical time was 35 (25-45) minutes and feeding was started at 24 (5-48) hours postoperatively. There were no vaginal or urethral injuries, no wound infections or dehiscenses. Throughout the 38 (12.75-45.50) months of follow-up there were no anal strictures. All patients are passing stool, 11 (61%) of them with the need of a low dose stool softener.

Conclusion: Selected patients with rectoperineal fistula can be treated with PRAA with a shorter surgical time and hospital stay. This technique provides good results and lower risk of injury to neighbouring structures.

保留肛门直肠畸形患者瘘管的直肠后方推进术。一项多中心研究。
背景:伴有直肠肛管瘘的肛门直肠畸形(ARM)主要采用后矢状位肛门直肠成形术(PSARP)进行修复,但由于瘘管靠近阴道和尿道,这可能具有挑战性。后直肠推进肛门成形术(PRAA)可保留瘘管前壁,而不留前或后矢状切口。它适用于瘘管前端部分被括约肌复合体包围的部分直肠肛管瘘 ARM 病例:方法:对接受PRAA治疗的肛门直肠瘘患者进行多中心回顾性研究。我们分析了性别、相关畸形、年龄、手术时间、短期和长期效果以及并发症:18名患者接受了PRAA手术,年龄为93.5(1.75-312)天。手术时间为35(25-45)分钟,术后24(5-48)小时开始喂食。无阴道或尿道损伤,无伤口感染或开裂。在 38 个月(12.75-45.50 个月)的随访中,没有出现肛门狭窄。所有患者都能排出粪便,其中 11 人(61%)需要使用小剂量软便剂:结论:部分直肠肛瘘患者可采用 PRAA 进行治疗,手术时间和住院时间较短。结论:部分直肠肛瘘患者可采用 PRAA 手术治疗,手术时间和住院时间较短,效果良好,对邻近结构造成损伤的风险较低。
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