title: Single-stage surgical correction of anorectal malformation associated with rectourinary fistula in male neonates.
abstract: BACKGROUND
  The treatment of children affected by anorectal malformations (ARM) is characterized by some unsolved problems. The three-stage surgical correction has been known to be most effective in preventing complications, but recently new approaches have been proposed. We describe our experience with the newer approaches.
  
  
  METHODS
  Twenty three male newborns, affected by ARM and recto-urinary fistula, were treated in 2 different centers in 8 years. Nineteen neonates (birth weight 2.4 - 3.5 kg) received a primary posterior sagittal anorectoplasty (PSARP) at the Department of Pediatric Surgery of the Chittagong Medical College Hospital (group 1). Four term neonates (birth weight 2.9 - 3.4 kg) received a primary pull-through with combined abdomino-perineal approach at the Pediatric Surgery Department of Fondazione Cà Granda of Milan (group 2).
  
  
  RESULTS
  Among patients of Group 1, 11 patients had a recto-bulbar fistula and 8 a recto-prostatic fistula. Among the Group 2, 2 had a recto-bulbar fistula and 2 a recto-prostatic fistula. The site of fistula was decided at the time of surgery. In Group 1, 5 post-surgical complications were recorded (26%); 1 child died of sepsis, 3 had dehiscence and 1 stenosis, which resolved with dilatation. In Group 2, the only post-operative complication of small rectal prolapse resolved spontaneously after a few months on follow-up. Group 2 patients were followed-up in a dedicated multidisciplinary colorectal center.
  
  
  CONCLUSIONS
  Primary repair of ARMs with recto-urinary fistula is a feasible, safe and effective technique in the neonatal period. A combined abdominal and perineal approach seems to guarantee better results. A dedicated team is mandatory, both for the surgical correction and for a long-term follow-up.
authors.affiliation: Dept. of Pediatric Surgery, FONDAZIONE IRCCS CA' GRANDA - Ospedale Maggiore Policlinico, Milan - Italy.
authors.forename: Ernesto
authors.initials: E
authors.lastname: Leva
authors.affiliation: Dept. of Pediatric Surgery, FONDAZIONE IRCCS CA' GRANDA - Ospedale Maggiore Policlinico, Milan - Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Macchini
authors.affiliation: Dept. of Pediatric Surgery, FONDAZIONE IRCCS CA' GRANDA - Ospedale Maggiore Policlinico, Milan - Italy.
authors.forename: Rossella
authors.initials: R
authors.lastname: Arnoldi
authors.affiliation: Dept. of Pediatric Surgery, FONDAZIONE IRCCS CA' GRANDA - Ospedale Maggiore Policlinico, Milan - Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Di Cesare
authors.affiliation: Dept. of Pediatric Surgery, FONDAZIONE IRCCS CA' GRANDA - Ospedale Maggiore Policlinico, Milan - Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Gentilino
authors.affiliation: Neonatal ICU, FONDAZIONE IRCCS CA' GRANDA - Ospedale Maggiore Policlinico, Milan - Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Fumagalli
authors.affiliation: Neonatal ICU, FONDAZIONE IRCCS CA' GRANDA - Ospedale Maggiore Policlinico, Milan - Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Mosca
authors.affiliation: Dept. of Pediatric Surgery, CHITTAGONG MEDICAL COLLEGE HOSPITAL, Chittagong - Bangladesh.
authors.forename: Akbar
authors.initials: A
authors.lastname: Bhuiyan
authors.affiliation: Dept. of Pediatric Surgery, FONDAZIONE IRCCS CA' GRANDA - Ospedale Maggiore Policlinico, Milan - Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Torricelli
authors.affiliation: Dept. of Pediatric Surgery, CHITTAGONG MEDICAL COLLEGE HOSPITAL, Chittagong - Bangladesh.
authors.forename: Tahmina
authors.initials: T
authors.lastname: Banu
keywords: Anorectal malformation; Primary repair; Recto-urinary fistula