Abstract
Introduction Postoperative constipation (PC) in patients with imperforate anus and perineal fistula
(PF) has been reported in up to 60%. Histological studies of PF revealed innervation
anomalies which seem to be one of the reasons for PC. Perioperative histologically
controlled fistula resection (PHCFR) allows appropriate resection of PF and pull-down
normoganglionic rectum at the time of posterior sagittal anorectoplasty (PSARP).
Materials and Methods A total of 665 patients with anorectal malformations underwent surgery between 1991
and 2021. Of these, 364 presented PF; 92 out of them (41 F) were studied. Patients
with sacral and spinal cord anomalies, neurological disorders, and cut-back anoplasty
were excluded. PSARP was done on all patients. Hematoxylin-eosin staining and NADH
Tetrazolium-reductase histochemical method were used. Four and more ganglion cells
in the myenteric plexus represented a sufficient length of the resection. The continence
was scored according to the modified Krickenbeck scoring system. Final scores ranged
from 1 to 7 points. Values are given as median.
Results A total of 65 (70.7%) patients presented an aganglionic segment in PF, and 27 patients
presented hypoganglionosis. The median length of the resected fistula was 25 mm (interquartile
range [IQR]: 20–30). The median total continence score was 7 (IQR: 6–7). Post-op constipation
was observed in 6/92 (6.5%) patients.
Conclusion PHCFR diminished PC to 6.5% of patients.
Keywords
anorectal malformations - perineal fistula - posterior sagittal anorectoplasty - perioperative
biopsy - chronic constipation - follow-up
