One-stage correction of recto-vestibular fistula by trans-fistula anorectoplasty (TFARP).
BACKGROUND
The present article details a new technique for the repair of recto-vestibular fistula.


METHODS
Twenty-five patients with recto-vestibular fistula, between 13 days and 4 years of age underwent surgical correction by trans-fistula ano-recto-plasty (TFARP). The technique, described in detail, involves mobilization of the fistula and the rectum through the fistula and creation of a new anus in the anatomically normal site by preserving both the perineal skin bridge (skin between the neo-anus and the posterior fourchette) and the levator muscle.


RESULTS
The mean operating time was 85 min, and the mean hospital stay was 5 days. Moderate anal stenosis developed in 1 patient and was treated successfully by anal dilatations using Hegar dilators. A diverting colostomy was not required in any patient, and none of the patients developed rectal prolapse. Eleven patients who are now 3 years of age or older have voluntary bowel movements with good fecal continence scores. The 14 neonates and infants, who are still too young to be evaluated for continence, have symmetric anal contraction to stimulation and strong squeeze on digital rectal examination. The average number of bowel movements per day was three to five, without the need for any laxative or enema.


CONCLUSIONS
Trans-fistula ano-recto-plasty is a simple surgical procedure that does not divide the levator muscle or the perineal body. Preservation of these structures contributes significantly toward improvement of the aesthetic appearance of the perineum and of fecal continence.
Pratap
Akshay
A
Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal. akshay_pratap2000@yahoo.co.in.
Yadav
Rohit Prasad
RP
Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
Shakya
Vikal Chandra
VC
Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
Agrawal
Chandra Shekhar
CS
Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
Singh
Satyendra Narayan
SN
Department of Anesthesia, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
Sen
Ritoban
R
Department of Surgery, B.P. Koirala Institute of Health Sciences, Dharan, Nepal.
D002675:Child, Preschool; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010502:Perineum / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012006:Rectovaginal Fistula / Q000151:congenital / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome