One Stage Anterior Sagittal Sphincter Saving Anorectoplasty (ASSSARP) for the Repair or Rectovestibular Fistula: Mid and Long-term Outcome in Two Tertiary Centers.

Abstract Purpose This is a retrospective study of 1-stage ASSSARP for RVF including operative details and postoperative complications, functional and cosmetic outcome. Patients and Methods: Records of 41 cases of RVF, managed between April 2010 and September 2019 by one-stage ASSSARP, were reviewed. Preoperative preparation, both early and late postoperative care & complications, hospital stay, and functional & cosmetic outcomes were reported. Results The mean age was 6.6 months. Vaginal tear 5/41 cases, and distal rectal tears 4/41 cases. Mild superficial wound inflammation; 13 patients, Skin dehiscence; 5 patients. No colostomy or redo was needed. The mean hospital stay was 6.1 days. Mean follow-up was 43.13 months; (Range; 24–100 months). Anal stricture; 6 patients. constipation occurred in 14 cases. Soiling grade I occurred in 5 patients. 32 patients > 3 years; 2 patients showed cough/diarrhea incontinence. Conclusion One-stage ASSSARP is safe and gives functional and cosmetic results comparable to other techniques. It provides better access to female anomalies. The avoidance of muscle incision protects against muscle breakdown, if infection sets in, and thus against incontinence. It avoids the morbidity, cost and psychological burden of performing a 3-stage repair.