title: The management of anorectal malformation with congenital vestibular fistula: a single-stage modified anterior sagittal anorectoplasty.
abstract: OBJECTIVE
  This study aimed to evaluate the mid-term outcomes of single-stage modified anterior sagittal anorectoplasty (ASARP) for anorectal malformation with vestibular fistula.
  
  
  METHODS
  Twenty-six patients with congenital imperforate anus and vestibular fistula underwent single-stage modified sphincter-saving ASARP between January 2008 and December 2012. The ages of the patients at the time of operation ranged from 1 month to 5.1 years. Standard ASARP procedure was modified to avoid the incision of the external sphincter complex. Instead a potential tunnel was created through the center of external sphincter complex under the endoscopic guidance. The patients were evaluated for fecal continence and complications.
  
  
  RESULTS
  Modified ASARP was successfully performed in all patients. The mean operation time was 52.2 ± 3.5 min (range 47-61 min). The operative blood loss was minimal. There was no operative complication. Wound infection occurred in 3 patients (3/26, 11.5%). All patients were followed up for 4.2 ± 1.5 years (range 2-6 years). No patient developed fecal incontinence. Three patients (3/26, 11.5%) had soiling once or twice per week. Four patients (4/26, 15.4%) had constipation amenable to diet management. Mucosal prolapse occurred in 1 patient (1/26, 3.8%). There was no recurrence of fistula, anal stenosis or anterior displacement of the neorectum.
  
  
  CONCLUSIONS
  Mid-term results show that single-stage modified ASARP is an effective and safe option for patients with anorectal malformation and congenital vestibular fistula.
authors.affiliation: Department of Pediatric Surgery, Capital Institute of Pediatrics, No. 2 Ya Bao Road, Beijing, 100020, People's Republic of China.
authors.forename: Chen
authors.initials: C
authors.lastname: Wang
authors.forename: Long
authors.initials: L
authors.lastname: Li
authors.forename: Shuli
authors.initials: S
authors.lastname: Liu
authors.forename: Zheng
authors.initials: Z
authors.lastname: Chen
authors.forename: Mei
authors.initials: M
authors.lastname: Diao
authors.forename: Xu
authors.initials: X
authors.lastname: Li
authors.forename: Guoliang
authors.initials: G
authors.lastname: Qiao
authors.forename: Wei
authors.initials: W
authors.lastname: Cheng
mesh_terms: D001003:Anal Canal / Q000002:abnormalities* / Q000601:surgery; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000601:surgery*; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D061646:Operative Time; D019651:Plastic Surgery Procedures / Q000379:methods*; D012003:Rectal Fistula / Q000151:congenital / Q000601:surgery*; D012007:Rectum / Q000002:abnormalities* / Q000601:surgery; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome