ANTERIOR SAGITTAL ANORECTOPLASTY FOR ANORECTAL-MALFORMATIONS AND PERINEAL TRAUMA IN THE FEMALE CHILD

Vestibular fistula and perineal ectopic anus are the most common anore ctal malformations in female children. Anterior saggital anorectoplast y (ASARP) was used to treat 416 patients with these anomalies, as well as cases of perineal canal and third-degree perineal tear, during a 2 0 year period. Preliminary colostomy was performed in only four patien ts, who had a perineal tear. For ASARP, a midline incision was made an d the rectum was separated from the vagina and placed in the center of the sphincteric muscle complex. The perineal body was reconstructed, and normal appearance of the perineum was achieved. Six patients had c omplications postoperatively (4 had secondary hemorrhage, 2 had wound infection). One patient with hemorrhage and one with infection require d laying open of the wound and revision surgery after 12 weeks. Both r ecovered well. Of the 416 patients, 397 returned for follow-up 12 week s after the surgery. Of these, 390 had a normal-looking perineum and n ormal defecation. Of the remaining seven patients, three had retractio n of the rectum, one had recurrence of the fistula, and another had ac quired perineal canal. These five children required revision ASARP and recovered successfully. The other two patients had mucosal prolapse, which reduced spontaneously. Three hundred twenty-six children of the 416 patients have had follow-up beyond the age of 3 years. Of these, 2 91 had normal bowel habits without the use of laxatives. Of the other 35, four had fecal impaction of unknown etiology, which was managed co nservatively, 6 bad anal stenosis (four underwent posterior Barrow's f lap interposition and two responded to dilatation), and 25 bad a poste rior ledge that caused constipation and required cutback. Overall, eig ht patients (1.9%) required revision ASARP and 40 others (9.8%) had mi nor complications. This operation provides consistently good results, and the authors recommend it for the management of anorectal malformat ions and perineal trauma in female children. Copyright (C) 1996 by W.B . Saunders Company