Vestibular Fistula: A Prospective Follow up Study for the Management of Anorectovestibular Fistula in Neonates

Introduction: Anorectal Malformation (ARM) is one of the common congenital anomalies in the world. Incidence worldwide is 1 in 3000 to 5000 live births. Anorectal malformation is a well-recognized condition since antiquity and represents a wide spectrum of defects. Anorecto-Vestibular fistula (ARVF) is the commonest ARM in female children. Recto‑Vestibular anus is the most common Anorectal Malformation (ARM) in female patients, in which rectum opens immediately behind the hymen in the vestibule. Aim of the Study: The aim of this study was to evaluate and compare the outcome between Trans- Fistula Anorectoplasty (TFARP) and Anterior Sagittal Anorectoplasty (ASARP) in the management of Recto-Vestibular Fistula (RVF) among neonates in a tertiary care hospital .Methods: This was a prospective comparative study and was conducted in the Faculty of Pediatric Surgery of Bangladesh Shishu Hospital & Institute, Dhaka, Bangladesh during the period from February 2017 to January 2021. In our study we took sixty (60) female neonates with vestibular fistula (VF). Among all neonates TFARP was done in 30 neonates and ASARP was done in 30 neonates for definitive correction of RVF. Result: In total 60 patients from both the groups completed the study. In our study we found the mean operation time in TFARP group and ASARP group was 65.97±4.63 minutes and 69.37±4.76 minutes. After operation, 60% neonates in TFARP group and 90% neonates in ASARP group developed complications. Most occurred complication was skin excoriation (20% & 26.67%) in TFARP & ASARP groups respectively. Wound dehiscence was noted significantly more in ASARP group. In TFARP group, 63.3% neonates had good, 33.3% neonates had fair and 3.3% neonates had poor functional score while in ASARP group, 56.7% neonates had good functional score & 43.3% neonates had fair functional score. Conclusion: In conclusion, we found that TFARP may provide the best postoperative cosmetic appearance, parent’s satisfaction, ..........