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Eur J Pediatr Surg
DOI: 10.1055/s-0043-1777101
Original Article

Perioperative Histologically Controlled Fistula Resection in Patients with Imperforate Anus and Perineal Fistula

Richard Skaba
1   Department of Paediatric Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
,
Vojtech Dotlacil
1   Department of Paediatric Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
,
Pavla Fuccillo
2   Department of Pathology and Molecular Medicine, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
,
Blanka Rouskova
1   Department of Paediatric Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
,
Lucie Pos
1   Department of Paediatric Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
,
Michal Rygl
1   Department of Paediatric Surgery, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
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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

Ethical Approval

This study received approval from the institutional ethical committee under No: EK – 646/22.




Publication History

Received: 22 February 2023

Accepted: 21 September 2023

Article published online:
28 November 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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