Early postoperative feeding in single-stage repair of anorectal malformation with vestibular or perineal fistula is not associated with increased wound complications

Introduction: The objective of this study is to assess the postoperative outcomes of single-stage repair of anorectal malformations with vestibular (VF) or perineal fistula (PF) and early initiation of postoperative feeding.Methods: A retrospective review of patients undergoing single-stage repair of isolated low anorectal mal-formations (VF and PF) from 2017 to 2020 was conducted. All patients underwent an anterior anoplasty with complete mobilization of the rectal fistula, or posterior sagittal anorectoplasty (PSARP), without pro-tective colostomy. The variables examined include age, timing of postoperative feeding initiation, length of stay (LOS), and complications.Results: Nineteen patients with VF or PF underwent a single-stage repair. 12/19 (63%) patients were fe-male. All 7 males and 9/12 females had a PF. The range of age at surgery was 2 days to 3 years with median age of 92 days [IQR 1,3: 9,193]. The median postoperative day for initiation of feeds was day 0 [IQR 1,3: 0,1] and median LOS was 1 day [IQR 1,3: 1,4.5]. 18/19 (95%) patients were evaluated in follow-up and there were no wound infections, wound dehiscences, or recurrent fistulas. Within 90 days postoper-atively, no patients were seen in the emergency department for postoperative issues. Within 6 months, 2/19 (11%) patients required an unplanned return to the operating room for anal dilation.Conclusion: In single-stage repair of isolated low anorectal malformations, VF and PF, early initiation of postoperative feeding is safe, results in a short length of stay, and does not lead to increased wound com-plications. Early enteral feeding eliminates the need for parenteral nutrition and central venous access, and their associated complications. Level of evidence: Level IV (c) 2022 Elsevier Inc. All rights reserved.