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Eur J Pediatr Surg 2023; 33(04): 328
DOI: 10.1055/s-0043-1770997
Letter to the Editor

Sparing the Perineal Body in the Vestibular Fistula

V.D. Upadhyaya
1   Department of Pediatric Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
,
A. Pandey 
2   Department of Pediatric Surgery, King George's Medical University, Lucknow, Uttar Pradesh, India
,
A.N. Gangopadhyay
3   Department of Pediatric Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Comment on:

Sparing the Perineal Body: A Modification of the Posterior Sagittal Anorectoplasty for Anorectal Malformations with Rectovestibular FistulaeEur J Pediatr Surg 2023; 33(06): 463-468
DOI: 10.1055/a-1976-3611

Sparing the Perineal Body: A Modification of the Posterior Sagittal Anorectoplasty for Anorectal Malformations with Rectovestibular Fistulae

Response to: Sparing the Perineal Body, A Modification of the Posterior Sagittal Anorectoplasty (PSARP) for Anorectal Malformations with Rectovestibular Fistulae

Dear editor,

We read an interesting article published by Badillo et al[1] about perineal body preservation in patients of vestibular fistula of rectovestibular (RVF) type. The authors attempted to preserve the perineal body by a modification of the standard posterior sagittal anorectoplasty (PSARP) procedure. It is of interest to note that a nearly similar article has been published in another journal.[2] Since the perineal body is important for pelvic floor support and continence,[1] its preservation is of utmost importance.

Both articles highlighting the importance of perineal body preservation, have avoided making the incision through the perineal body. The authors of the present paper have claimed it to be a novel modification of the original PSARP procedure. However, after the literature review, we noted that the first such paper about preserving the perineal body in RVF patients was by our group.[3] It was published in 2008 and included 40 patients. The authors should have included it in their discussion.

The novelty of the current paper is the claim of making the incision only in the proposed anal site. The other paper published[2] has a bigger incision in comparison with the present paper. Our incision was also bigger[3] in comparison with the present study. Since the number of patients was minimal in this study (4 patients), and three were having a covering colostomy, a detailed follow-up and inclusion of more patients will provide further insights into this technique. Since the technique seems to be trickier than the standard PSARP, the authors may have highlighted the technical difficulties, limitations of the surgical technique, and the patient selection criteria.

About the shortcomings of anterior sagittal anorectoplasty, we would like to say that one has to master the procedure. It is a simple procedure, and it is routinely performed in many centers in India. The rectal mobilization should be up to the posterior fornix to prevent the problems mentioned by the authors.

We are excited to see that new work is being conducted on the same principles mentioned by us in 2008, and hope to see good results of the present technique in time to come.



Publication History

Received: 02 May 2023

Accepted: 26 May 2023

Article published online:
05 July 2023

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  • References

  • 1 Badillo A, Tiusaba L, Jacobs SE. et al. Sparing the perineal body: a modification of the posterior sagittal anorectoplasty for anorectal malformations with rectovestibular fistulae. Eur J Pediatr Surg 2023;
    Thieme ConnectPubMedSearch in Google Scholar
  • 2 Ostertag-Hill CA, Nandivada P, Dickie BH. Saving the perineal body-a modification of the posterior sagittal anorectoplasty. Pediatr Surg Int 2023; 39 (01) 71
    CrossrefPubMedSearch in Google Scholar
  • 3 Upadhyaya VD, Gangopadhyay AN, Pandey A. et al. Single-stage repair for rectovestibular fistula without opening the fourchette. J Pediatr Surg 2008; 43 (04) 775-779
    CrossrefPubMedSearch in Google Scholar