Karakus Suleyman Cuneyt, User Idil Rana, Akcaer Vedat, Ceylan Haluk, Ozokutan Bulent Hayri
Department of Pediatric Surgery, Faculty of Medicine, University of Gaziantep, 27310, Gaziantep, Turkey.
Pediatr Surg Int. 2017 Jul;33(7):755-759. doi: 10.1007/s00383-017-4102-7. Epub 2017 Jun 5.
The aim of this study is to compare the results and complications of one- and three-stage repairs in females with vestibular fistula (VF) and make contribution to the discussion of whether the disadvantages outweigh the protective effect of a colostomy from wound infection and wound dehiscence following posterior sagittal anorectoplasty (PSARP).
Patients with a diagnosis of VF who underwent PSARP between October 2009 and November 2015 were retrospectively reviewed. The patients were divided into two groups: Group 1-patients treated by one-stage procedure (n = 30); Group 2-patients treated by three-stage procedure (n = 16).
There were no statistically significant differences between the groups with respect to wound infection, recurrence of fistula and rectal mucosal prolapse. Minor wound dehiscence occurred slightly more common in Group 1, even if p value is not significant. No wound dehiscence has been observed since we switched to the protocol of keeping the child nil per oral for 5 postoperative days and loperamide (0.1 mg/kg) administration for 7 postoperative days. The mean time before resuming oral intake was 2.87 ± 1.7 and 1.19 ± 0.4 days in Group 1 and Group 2, respectively (p = 0.001). None developed major wound disruption or anal stenosis in either group. There were no statistical differences between the groups in terms of voluntary bowel movements, soiling and constipation.
PSARP performed without a protective colostomy in patients with VF has low morbidity, good continence rates and obvious advantages for both the patients and their parents.
本研究旨在比较女性前庭瘘（VF）一期修复和三期修复的结果及并发症，为讨论在经后矢状位肛门直肠成形术（PSARP）后结肠造口术预防伤口感染和伤口裂开的保护作用是否大于其弊端做出贡献。
回顾性分析2009年10月至2015年11月期间接受PSARP治疗的VF患者。患者分为两组：第1组——接受一期手术治疗的患者（n = 30）；第2组——接受三期手术治疗的患者（n = 16）。
两组在伤口感染、瘘管复发和直肠黏膜脱垂方面无统计学显著差异。第1组轻微伤口裂开的发生略为常见，即使p值不显著。自从我们改为术后5天禁食、术后7天给予洛哌丁胺（0.1 mg/kg）的方案后，未观察到伤口裂开。第1组和第2组恢复经口进食的平均时间分别为2.87±1.7天和1.19±0.4天（p = 0.001）。两组均未发生严重伤口破裂或肛门狭窄。两组在自主排便、污粪和便秘方面无统计学差异。
VF患者在未行保护性结肠造口的情况下进行PSARP，发病率低，控便率良好，对患者及其家长均具有明显优势。
