title: Outcome of patients after single-stage repair of perineal fistula without colostomy according to the Krickenbeck classification.
abstract: OBJECTIVE
  The aim of the study is to assess the characteristics and outcome of anorectal malformation (ARM) patients who underwent single-stage repair of perineal fistula without colostomy according to the Krickenbeck classification.
  
  
  METHODS
  From 2002 to 2013, twenty-eight males and four females with perineal fistula who underwent single-stage repair without colostomy in our institute were included in this study. Patients with perineal fistula who underwent staged repair were excluded. Demographics, associated anomalies, and operative complications were recorded. The type of surgical procedures and functional outcome were assessed using the Krickenbeck classification.
  
  
  RESULTS
  Six patients had associated anomalies, including two patients with renal, two with cardiac, one with vertebral, and one with limb abnormalities. Thirteen patients underwent perineal operation, and fourteen patients underwent anterior sagittal approach in the neonatal period. One patient underwent anterior sagittal approach, and four patients underwent PSARP beyond the neonatal period. One patient had an intra-operative urethral injury and one a vaginal injury. Complications were not associated with the type of surgical procedure (p=0.345). All perineal wounds healed without infection. By using the Krickenbeck assessment score, all sixteen children older than five years of age had voluntary control. One patient had grade 1 soiling, and no patient had constipation.
  
  
  CONCLUSIONS
  Single-stage operation without colostomy was safe with good outcomes in patients with perineal fistula. The use of Krickenbeck classification allows standardization in assessment on the surgical approach and on functional outcome in ARM patients.
authors.affiliation: Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong. Electronic address: edwinchan@surgery.cuhk.edu.hk.
authors.forename: Kin Wai Edwin
authors.initials: KW
authors.lastname: Chan
authors.affiliation: Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Kim Hung
authors.initials: KH
authors.lastname: Lee
authors.affiliation: Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Hei Yi Vicky
authors.initials: HY
authors.lastname: Wong
authors.affiliation: Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Siu Yan Bess
authors.initials: SY
authors.lastname: Tsui
authors.affiliation: Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Yuen Shan
authors.initials: YS
authors.lastname: Wong
authors.affiliation: Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Kit Yi Kristine
authors.initials: KY
authors.lastname: Pang
authors.affiliation: Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Jennifer Wai Cheung
authors.initials: JW
authors.lastname: Mou
authors.affiliation: Division of Paediatric Surgery and Paediatric Urology, Department of Surgery, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
authors.forename: Yuk Him
authors.initials: YH
authors.lastname: Tam
mesh_terms: D002648:Child; D002675:Child, Preschool; D003125:Colostomy; D005260:Female; D005402:Fistula / Q000145:classification / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D010502:Perineum / Q000002:abnormalities*; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Anorectal malformation; Krickenbeck; Perineal fistula; Single stage repair