Subscribe to RSS
A Modification of the Anoplasty Technique during a Posterior Sagittal Anorectoplasty and Anorectal Vaginal Urethroplasty Closure: The Para-U-Stitch to Prevent Wound Dehiscence
Objective Wound dehiscence after posterior sagittal anorectoplasty (PSARP) or anorectal vaginal urethroplasty (PSARVUP) for anorectal malformation (ARM) is a morbid complication. We present a novel anoplasty technique employing para-U-stitches along the anterior and posterior portions of the anoplasty, which helps buttress the midline U-stitch and evert the rectal mucosa. We hypothesized that, in addition to standardized pre- and postoperative protocols, this technique would lower rates of wound dehiscence.
Materials and Methods A retrospective review of patievnts who underwent primary PSARP or PSARVUP with the para-U-stitch technique from 2015 to 2021 was performed. Wound dehiscence was defined as wound disruption requiring operative intervention within 30 days of the index operation. Superficial wound separations were excluded. Descriptive statistics were calculated. The final cohort included 232 patients.
Results Rectoperineal fistula (28.9%) was the most common ARM subtype. PSARP was performed in 75% and PSARVUP in 25%. The majority were reconstructed with a stoma in place (63.4%). Wound dehiscence requiring operative intervention occurred in four patients, for an overall dehiscence rate of 1.7%. The dehiscence rate was lower in PSARPs compared with PSARVUPs (0.6 vs. 5.2%) and lower for reconstruction without a stoma compared with a stoma (1.2 vs. 2.0%). There were additional six patients (2.6%) with superficial wound infections managed conservatively.
Conclusion We present the para-U-stitch anoplasty technique, which is an adjunct to the standard anoplasty during PSARP and PSARVUP. In conjunction with standardized pre- and postoperative protocols, this technique can help decrease rates of wound dehiscence in this patient population.
Received: 19 December 2022
Accepted: 19 January 2023
Accepted Manuscript online:
24 January 2023
Article published online:
07 March 2023
© 2023. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Levitt MA, Peña A. Anorectal malformations. Orphanet J Rare Dis 2007; 2 (01) 33 DOI: 10.1186/1750-1172-2-33.
- 2 Divarci E, Ergun O. General complications after surgery for anorectal malformations. Pediatr Surg Int 2020; 36 (04) 431-445
- 3 Tainaka T, Uchida H, Tanaka Y. et al. Long-term outcomes and complications after laparoscopic-assisted anorectoplasty vs. posterior sagittal anorectoplasty for high- and intermediate-type anorectal malformation. Pediatr Surg Int 2018; 34 (10) 1111-1115
- 4 Tofft L, Salö M, Arnbjörnsson E, Stenström P. Wound dehiscence after posterior sagittal anorectoplasty in children with anorectal malformations. BioMed Res Int 2018; 2018: 2930783 DOI: 10.1155/2018/2930783.
- 5 Khalifa M, Shreef K, Al Ekrashy MA, Gobran TA. One or two stages procedure for repair of rectovestibular fistula: which is safer? (a single institution experience). Afr J Paediatr Surg 2017; 14 (02) 27-31
- 6 Karakus SC, User IR, Akcaer V, Ceylan H, Ozokutan BH. Posterior sagittal anorectoplasty in vestibular fistula: with or without colostomy. Pediatr Surg Int 2017; 33 (07) 755-759
- 7 Hartford L, Brisighelli G, Gabler T, Westgarth-Taylor C. Single-stage procedures for anorectal malformations: a systematic review and meta-analysis. J Pediatr Surg 2022; 57 (09) 75-84
- 8 Kumar B, Kandpal DK, Sharma SB, Agrawal LD, Jhamariya VN. Single-stage repair of vestibular and perineal fistulae without colostomy. J Pediatr Surg 2008; 43 (10) 1848-1852
- 9 Amanollahi O, Ketabchian S. One-stage vs. three-stage repair in anorectal malformation with rectovestibular fistula. Afr J Paediatr Surg 2016; 13 (01) 20-25
- 10 Cho MJ, Kim TH, Kim DY, Kim SC, Kim IK. Clinical experience with persistent cloaca. J Korean Surg Soc 2011; 80 (06) 431-436
- 11 Versteegh HP, Sloots CEJ, de Jong JR. et al. Early versus late reconstruction of cloacal malformations: the effects on postoperative complications and long-term colorectal outcome. J Pediatr Surg 2014; 49 (04) 556-559
- 12 Versteegh HP, Sutcliffe JR, Sloots CEJ, Wijnen RMH, de Blaauw I. Postoperative complications after reconstructive surgery for cloacal malformations: a systematic review. Tech Coloproctol 2015; 19 (04) 201-207
- 13 Pediatric Colorectal and Pelvic Learning Consortium (PCPLC). Accessed February 9, 2023, at: https://www.pcplc.org/
- 14 Ohman KA, Wan L, Guthrie T. et al. Combination of oral antibiotics and mechanical bowel preparation reduces surgical site infection in colorectal surgery. J Am Coll Surg 2017; 225 (04) 465-471
- 15 deVries PA, Peña A. Posterior sagittal anorectoplasty. J Pediatr Surg 1982; 17 (05) 638-643
- 16 Nelson RL, Gladman E, Barbateskovic M. Antimicrobial prophylaxis for colorectal surgery. Cochrane Database Syst Rev 2014; 2014 (05) CD001181 DOI: 10.1002/14651858.CD001181.pub4.
- 17 Ahmad H, Nordin AB, Halleran DR. et al. Decreasing surgical site infections in pediatric stoma closures. J Pediatr Surg 2020; 55 (01) 90-95
- 18 Hofmeester MJ, Draaisma JMTH, Versteegh HP, Huibregtse ECP, van Rooij IALM, de Blaauw I. Perioperative nutritional management in congenital perineal and vestibular fistulas: a systematic review. Eur J Pediatr Surg 2015; 25 (05) 389-396
- 19 Kuijper CF, Aronson DC. Anterior or posterior sagittal anorectoplasty without colostomy for low-type anorectal malformation: how to get a better outcome?. J Pediatr Surg 2010; 45 (07) 1505-1508
- 20 Reck-Burneo CA, Skerrit C, Dingemans A. et al. Primary or redo posterior sagittal anorectoplasty without a stoma: to feed or not to feed?. Eur J Pediatr Surg 2019; 29 (02) 150-152
- 21 Ahmad H, Skeritt C, Halleran DR. et al. Are routine postoperative dilations necessary after primary posterior sagittal anorectoplasty? A randomized controlled trial. J Pediatr Surg 2021; 56 (08) 1449-1453