title: Management of anorectal malformation without ligation of fistula: an approach preventing posterior urethral diverticula.
abstract: OBJECTIVE
  The posterior urethral diverticulum is a common urologic complication requiring reoperations in anorectal malformation cases (ARM). We present a series of 24 cases of male ARM managed without ligation of fistula.
  
  
  METHODS
  A prospective study was conducted between July 2010 and June 2012 including male neonates with ARM, where rectobladder neck and rectoprostatic fistula were approached by the abdominal route. The fistulous tract was dissected to the distal-most possible length and was excised flush with the urethra without its ligation. A per-urethral catheter was placed in situ. A record was made of any features of urinary leak and a micturating cystourethrogram was performed at the 1-year of follow-up.
  
  
  RESULTS
  Twenty-four cases of ARM, 16 with rectobladder neck fistula and eight cases with rectoprostatic fistula were included. Of these, 12 had single-stage primary abdominoperineal pull-through and 10 were managed by primary posterior sagittal anorectoplasty. Two cases with colostomy during the neonatal period were managed by laparoscopic assisted anorectoplasty at 6 months. None of the cases had a urinary leak during the postoperative period. All had a normal micturating cystourethrogram at 1 year.
  
  
  CONCLUSIONS
  The approach of dividing fistula without ligation may prevent posterior urethral diverticula, but larger long-term follow-up studies are needed.
authors: Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India. Electronic address: sunny.imsbhu@gmail.com.
authors: Vaibhav
authors: V
authors: Pandey
authors: Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India.
authors: Ajay N
authors: AN
authors: Gangopadhyay
authors: Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India.
authors: Dinesh K
authors: DK
authors: Gupta
authors: Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India.
authors: Shiv P
authors: SP
authors: Sharma
authors: Department of Paediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, UP, India.
authors: Vijayendar
authors: V
authors: Kumar
mesh_terms: D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000601:surgery*; D004240:Diverticulum / Q000517:prevention & control*; D006801:Humans; D008026:Ligation; D008297:Male; D011446:Prospective Studies; D014522:Urethral Diseases / Q000517:prevention & control*; D014525:Urethral Stricture; D013521:Urologic Surgical Procedures, Male / Q000379:methods*
keywords: Anorectal malformation; Anorectoplasty; Posterior urethral diverticula; Rectourethral fistula