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Leva E, Macchini F, Arnoldi R, et al. Single-stage surgical correction of anorectal malformation associated with rectourinary fistula in male neonates. J Neonatal Surg. 2013;2(1):3
Leva, E., Macchini, F., Arnoldi, R., Di Cesare, A., Gentilino, V., Fumagalli, M., Mosca, F., Bhuiyan, A., Torricelli, M., & Banu, T. (2013). Single-stage surgical correction of anorectal malformation associated with rectourinary fistula in male neonates. Journal of neonatal surgery, 2(1), 3.
Leva, Ernesto, et al. "Single-stage surgical correction of anorectal malformation associated with rectourinary fistula in male neonates." Journal of neonatal surgery vol. 2,1 (2013): 3.
Leva E, Macchini F, Arnoldi R, Di Cesare A, Gentilino V, Fumagalli M, Mosca F, Bhuiyan A, Torricelli M, Banu T. Single-stage surgical correction of anorectal malformation associated with rectourinary fistula in male neonates. J Neonatal Surg. 2013 Jan 01;2(1):3. eCollection 2013. PMID: 26023423; PMCID: PMC4420348.
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J Neonatal Surg. 2013 Jan 01;2(1):3. eCollection 2013.

Single-stage surgical correction of anorectal malformation associated with rectourinary fistula in male neonates.

Journal of neonatal surgery

Ernesto Leva, Francesco Macchini, Rossella Arnoldi, Antonio Di Cesare, Valerio Gentilino, Monica Fumagalli, Fabio Mosca, Akbar Bhuiyan, Maurizio Torricelli, Tahmina Banu

Affiliations

  1. Dept. of Pediatric Surgery, FONDAZIONE IRCCS CA' GRANDA - Ospedale Maggiore Policlinico, Milan - Italy.
  2. Neonatal ICU, FONDAZIONE IRCCS CA' GRANDA - Ospedale Maggiore Policlinico, Milan - Italy.
  3. Dept. of Pediatric Surgery, CHITTAGONG MEDICAL COLLEGE HOSPITAL, Chittagong - Bangladesh.

PMID: 26023423 PMCID: PMC4420348

Abstract

INTRODUCTION: The treatment of children affected by anorectal malformations (ARM) is characterized by some unsolved problems. The three-stage surgical correction has been known to be most effective in preventing complications, but recently new approaches have been proposed. We describe our experience with the newer approaches.

METHODS: Twenty three male newborns, affected by ARM and recto-urinary fistula, were treated in 2 different centers in 8 years. Nineteen neonates (birth weight 2.4 - 3.5 kg) received a primary posterior sagittal anorectoplasty (PSARP) at the Department of Pediatric Surgery of the Chittagong Medical College Hospital (group 1). Four term neonates (birth weight 2.9 - 3.4 kg) received a primary pull-through with combined abdomino-perineal approach at the Pediatric Surgery Department of Fondazione Cà Granda of Milan (group 2).

RESULTS: Among patients of Group 1, 11 patients had a recto-bulbar fistula and 8 a recto-prostatic fistula. Among the Group 2, 2 had a recto-bulbar fistula and 2 a recto-prostatic fistula. The site of fistula was decided at the time of surgery. In Group 1, 5 post-surgical complications were recorded (26%); 1 child died of sepsis, 3 had dehiscence and 1 stenosis, which resolved with dilatation. In Group 2, the only post-operative complication of small rectal prolapse resolved spontaneously after a few months on follow-up. Group 2 patients were followed-up in a dedicated multidisciplinary colorectal center.

CONCLUSIONS: Primary repair of ARMs with recto-urinary fistula is a feasible, safe and effective technique in the neonatal period. A combined abdominal and perineal approach seems to guarantee better results. A dedicated team is mandatory, both for the surgical correction and for a long-term follow-up.

Keywords: Anorectal malformation; Primary repair; Recto-urinary fistula

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