Safety & Cost-Effectiveness of Primary Neonatal Posterior Sagittal Ano-recto Plasty (PNPSARP)

Background: Early repair of Anorectal malformation (ARM) within 6 months may be one of the factors that improve fecal continence. Delayed and multiple-stage repairs require dilatation, strict bowel preparation, fasting and total parenteral nutrition (TPN). PNPSARP requires neither bowel preparation nor parenteral nutrition. We believe it can be achieved within 72 hours of life.Aim: To evaluate the safety, feasibility and cost effectiveness of PNPSARP within 72 hours of life versus delayed or multiple-stage repair of vestibular and perineal fistula. Material & Methods: A retrospective study was carried out of all newborns with ARM at our institute between August 2016 and August 2019. PNPSARP within 72 hours of life was compared with delayed or multiple-stage repair. Neither bowel preparation nor parenteral nutrition was required in the PNPSRP group. Perioperative complications and costs were evaluated. Results: Eight PNPSARP were compared with 7 delayed or multiple stage repair over the study period. Four babies (50%) were operated at day 1 post delivery in the PNPSARP group. Mean operative time (MOT) was 109 minutes (68-155). Mean follow up period was 22 months (12-36). One girl with a vestibular fistula had wound infection. This group had a good outcome with no morbidity, high satisfaction rate and low costs in comparison to delayed or multiple-stage repair.Conclusions: PNPSARP for perineal and vestibular fistula with supportive ancillary services in the first few days of life appears to be safe and cost effective with minimal morbidity. PNPSARP is now the standard technique in our unit.