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Eur J Pediatr Surg 2025; 35(02): 141-146
DOI: 10.1055/a-2514-7244
Original Article

Anorectal Malformation with Rectoperineal Fistula in Males Treated with a Posterior Rectal Advancement Anoplasty: Report of Early Outcomes

Thomas O. Xu 
1   Department of Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, United States
,
Inbal Samuk
2   Division of Colorectal Surgery, Schneider Children's Medical Center of Israel, Tel Aviv, Israel
,
Christina Feng
3   Department of Surgery, Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, United States
,
Richard J. Wood
4   Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, Ohio, United States
,
Andrea Badillo
1   Department of Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, United States
,
Marc A. Levitt
3   Department of Surgery, Colorectal and Pelvic Reconstructive Surgery, Children's National Hospital, Washington, District of Columbia, United States
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Abstract

Objective A novel modification of the cutback procedure, a posterior rectal advancement anoplasty (PRAA) for select male patients with an anorectal malformation and a rectoperineal fistula was recently described, which incised only within the limits of the sphincteric ellipse and eliminated an anterior rectal dissection and thus avoiding any possibility of a urethral injury. This report provides longer-term postoperative outcomes after PRAA.

Method A retrospective, single-institution study was performed examining male patients with a rectoperineal fistula between January 2020 and December 2023. PRAA was done only if the rectoperineal fistula was located within the anterior extent of the sphincteric ellipse, which was true for all patients encountered during this study period. We assessed postoperative outcomes, length of stay, time to first feeding, and early stooling patterns.

Results Eighteen patients underwent PRAA at a median age of 5.4 months (range 1 day–8 months) with a median follow-up of 14 months (range 4–40). Seven patients (39%) were repaired within the first month of life. Thirteen (72%) were repaired primarily and five (28%) had a diverting ostomy placed before referral. There were no instances of wound dehiscence, rectal prolapse, or urethral injury. Two (11%) patients developed an anal stricture requiring dilation or Heineke–Mikulicz anoplasty. All patients resumed feeds on postoperative day one. Median discharge was on postoperative day one (range 1–6). Fifteen (83%) were utilizing laxatives at their most recent follow-up.

Conclusion The PRAA avoids any potential urethral injury or perineal dehiscence has a low rate of anal stenosis (11%) and appears to be applicable to all male patients with a rectoperineal fistula. The technique allows for early return to diet and discharge and can be safely done in the neonatal period or in a delayed fashion without the need for a stoma.

Level of Evidence Level III.

Keywords

anorectal malformations - perineal fistula - operative technique - posterior sagittal anorectoplasty

Meeting Presentation

Oral presentation at the European Union Pediatric Surgery Association in June 2024.


Authors' Contributions

Conceptualization and design: T.X., M.L., A.B., R.W., and C.F.


Data collection, data analysis, and original manuscript preparation: T.X.


Editing and writing: T.X., R.H., I.S., C.F., E.T., R.W., A.B., and M.L.


Supervision: M.L.


Financial Disclosures

None.




Publication History

Received: 18 October 2024

Accepted: 10 January 2025

Accepted Manuscript online:
13 January 2025

Article published online:
24 March 2025

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