Khalifa Mohammed, Shreef Khalid, Al Ekrashy Mohammad Ahmad, Gobran Tarek Abdelazim
Department of Pediatric Surgery, Zagazig University, Zagazig, Egypt.
Department of Pediatric Surgery, Zagazig University Hospital, Zagazig, Egypt.
Afr J Paediatr Surg. 2017 Apr-Jun;14(2):27-31. doi: 10.4103/ajps.AJPS_61_16.
Rectovestibular fistula (RVF) is the most common type of anorectal malformations in females. The need for a diverting colostomy during correction of defect has ignited a heated debate. In this study, we reviewed the girls with RVF that had been treated by either one or two stage procedure in the past 10 years in our institution to define whether one stage or two stage procedures is safer and more beneficial for the patients.
Seventy girls with RVF that had been operated from January 2005 to January 2015 were studied retrospectively. Data were obtained from medical hospital records. The cases were divided into two groups. Group A (46 patients): were operated by two stages technique (simultaneous sigmoid colostomy and anterior sagittal anorectoplasty [ASARP]). Group B (24 patients): were operated by one stage (ASARP without covering colostomy). The short-term outcome as regard wound infection, wound dehiscence, anal stenosis, anal retraction, recurrence of fistula as well as complications of colostomy was reported. The long-term outcome as regard soiling, constipation and voluntary bowel movement was evaluated.
The age of patients at the time of surgery ranged from 3 months to 2 years (mean; 9.5 months). In Group A, seven patients (15.2%) developed wound infection, two patients developed wound disruption. One patient developed anterior anal retraction and required redo-operation, anal stenosis was noticed in five (10.9%) patients. Complications from colostomy had occurred in nine patients (19.5%). In Group B, wound infection occurred in ten patients (41.7%). Seven patients (29.2%) developed wound disruption. Anal stenosis occurred in eight patients (33.3%). Five patients required redo-operation because of anal retraction in three patients and recurrence of fistula in the other two patients. Constipation recorded in 15 patients (32.6%) of Group A and in ten patients (41.3%) of Group B. Soiling was reported in six girls (13.04%) of Group A and five girls (20.8%) of Group B.
The avoidance of colostomy is not outweighed achieving sound operation and continent child. Two stages correction of RVF is safer and more beneficial than one stage procedure, especially in our locality and for our paediatric surgeons during their learning curve.
直肠前庭瘘（RVF）是女性最常见的一种肛门直肠畸形。在修复缺损过程中是否需要进行转流性结肠造口术引发了激烈的争论。在本研究中，我们回顾了过去10年在我们机构接受一期或二期手术治疗的RVF女童，以确定一期手术还是二期手术对患者更安全、更有益。
回顾性研究2005年1月至2015年1月期间接受手术的70例RVF女童。数据来自医院病历。病例分为两组。A组（46例患者）：采用两阶段技术（同期乙状结肠造口术和经腹会阴肛门直肠成形术[ASARP]）进行手术。B组（24例患者）：采用一期手术（无覆盖结肠造口的ASARP）。报告了伤口感染、伤口裂开、肛门狭窄、肛门回缩、瘘管复发以及结肠造口术并发症等短期结局。评估了大便失禁、便秘和自主排便等长期结局。
手术时患者年龄为3个月至2岁（平均9.5个月）。A组中，7例患者（15.2%）发生伤口感染，2例患者出现伤口裂开。1例患者出现肛门前方回缩，需要再次手术，5例（10.9%）患者出现肛门狭窄。9例患者（19.5%）发生结肠造口术并发症。B组中，10例患者（41.7%）发生伤口感染。7例患者（29.2%）出现伤口裂开。8例患者（33.3%）出现肛门狭窄。5例患者因3例肛门回缩和另外2例瘘管复发需要再次手术。A组15例患者（32.6%）和B组10例患者（41.3%）出现便秘。A组6名女童（13.04%）和B组5名女童（20.8%）报告有大便失禁。
避免结肠造口术并不比实现良好的手术效果和使患儿大便能自控更重要。RVF的二期修复比一期手术更安全、更有益，尤其是在我们当地以及对于我们的儿科外科医生在其学习曲线阶段而言。
