Pradip Kumar Deuri1

BACKGROUND Rectovestibular fistula is the most common intermediate type of anorectal malformation in female. Traditionally rectovestibular fistula is treated with 3 stage procedure by creation of colostomy, definitive surgery, and subsequent colostomy closure. The aim of this study is to determine the feasibility, safety, cost effectiveness, outcome and advantage of performing new technique of Fourchette Preservation Primary Posterior Sagittal Anorectoplasty for treatment of intermediate anorectal malformations with rectovestibular fistula in female infants. METHODS 20 female neonates presented with rectovestibular fistula were included in the study from January 2013 to January 2016. The age of the operation is between 30-45 days. All female infants presenting with anorectal malformations were diagnosed by clinical examination, with presence of meconium stain in vaginal introitus, and probing the fistula tract with small Hegar’s dilator for presence of fistula. The inclusion criteria included clinically probe diagnosed fistula tract with passing stool. Initially all the patients were put on fistula tract dilatation once in a week for 1 to 4 weeks. Subsequently all the patients underwent Fourchette Preservation Primary Posterior Sagittal Anorectoplasty within age of 30-45 days and kept nil by mouth strictly for first 4 to 5 days postoperatively. Patients with rectovaginal fistula, none detected rectovestibular fistula with abdominal distension and associated major anomalies were excluded from the study. This is a retrospective study of female infants with Fourchette Preservation Primary Posterior Sagittal Anorectoplasty procedure done for Intermediate Anorectal Malformations with Rectovestibular Fistula in female infants in our institute from January 2013 to January 2016. RESULTS All patients had intermediate anomalies. A total of 20 patients was included in the study. Mean operative time was 90 minutes range being 60-120 minutes and blood loss less than 20 ml. Early postoperative complications include 2 cases of opening of posterior vaginal wall and 3 cases of superficial wound infection. No perineal wound disruption, rectal prolapse and anal stenosis were seen. All patients had passed stool 2-3 times per day. No patients required anal dilatations, laxatives and or enema. All patients were followed for 3 to 24 months. CONCLUSIONS Fourchette Preservation Primary Posterior Sagittal Anorectoplasty for Rectovestibular Fistula is feasible, safe and cost effective provided strict adherence to inclusion criteria. It has additional advantage of avoiding colostomy and associated complications.