PRIMARY POSTERIOR SAGITTAL ANORECTOPLASTY WITHOUT COLOSTOMY IN NEONATES WITH HIGH IMPERFORATE ANUS

The standard approach to management of high imperforate anus is colostomy in the newborn period followed by posterior saggital anorectoplasty (PSARP) at 6 to 12 months of age. The purpose of this study was to determine whether a one-stage repair by primary PSARP in the newborn period could be performed without clear determent to the patient’s functional result. Totally 30 newborns with high imperforate anus who underwent primary PSARP without colostomy were studied retrospectively. All cases were studied by sonography, echocardiography, lower vertebra X-ray and finally routine blood and urine laboratory tests. Incontinence was defined as fecal soiling at least twice a day, and patients requiring more than office dilatation were described to have stricture formation. All patients recovered well and were followed for periods ranging from 1.5 to 10 years. There were 3 cases of postoperative wound infection, but no anastomotic dehiscence, stricture formation and fistula recurrence were seen. In cases of constipation and fecal incontinence there were associated anomalies such as sacral dysplasia, kidney dysplasia, ventricular septal defect and vesicoureteral reflux. There were no complications in other cases. The most important factor is patient selection, and one-stage PSARP spares the patient the morbidity of additional surgeries in the standard multistage approach for high imperforate anus. These preliminary results suggest that one-stage PSARP is a safe and viable approach to the management of high imperforate anus without clear determent to future bowel function.