Title:The Treatment of Congenital Recto-vestibular Fistula and Recto-perineal
Fistula, and the Effects of the Megarectum on Defecation
Volume: 20
Author(s): Jian Li, Jinyu Dai, Xiaoxia Wu and Xiaobing Sun*
Affiliation:
- Department of Pediatric Surgery, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Third Hospital of Shanxi
Medical University, Taiyuan, 030032, China
- Department of Pediatric Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
Keywords:
Anorectal, Malformation, Recto-vestibular fistula, Recto-perineal fistula, Megarectum, Constipation.
Abstract:
Objective:
This study aims to discuss the treatment of congenital recto-vestibular fistula and recto-perineal fistula, and the effect of the megarectum on
defecation.
Background:
Congenital recto-vestibular fistula or recto-perineal fistula is the most common type of anorectal malformation, and surgical methods include
posterior sagittal anorectoplasty, anterior sagittal anorectoplasty, and mid-sagittal anorectoplasty, which can be performed at stage one or stage two
after the ostomy. In the later stages of a recto-vestibular fistula, constipation is a common complication. Rectal dilatation is frequently associated
with constipation, and the effect of rectal dilatation on defecation should be discussed for patients with congenital recto-vestibular or recto-perineal
fistula who had rectal dilatation prior to surgery. Rectal dilatation may be one of the causes of constipation for congenital recto-vestibular fistula
and recto-perineal fistula.
Methods:
The patients in this study were 67 children with congenital recto-vestibular fistula or recto-perineal fistula treated in our hospital from March 2013
to February 2017. All patients underwent an MRI of the spine and a barium enema. Six patients with myelodysplasia and sacral agenesis were
excluded from this study. There were 18 patients with rectal dilatation (ages: 4-month-old to 1 year old, male: 3, female: 15). Seven of them had
anterior sagittal anorectoplasty (group A), and 11 had anorectoplasty with dilated rectum resection (group B). Forty-three patients (ages: 3- to 10
months old, male: 6; female: 37) without a dilated rectum underwent anterior sagittal anorectoplasty (group C).
Results:
All patients were followed up for 1 year to 5 years. Among the 50 patients who had undergone an anoplasty, 5 out of 7 patients with rectal
dilatation developed post-operative constipation, and 3 of them had normal defecation after the second resection of the dilated rectum. Only two
out of 43 patients without rectal dilatation developed post-operative constipation. One out of 11 patients with rectal dilatation who underwent
anoplasty and resection of the dilated rectum developed post-operative constipation.
Conclusion:
Patients with congenital recto-vestibular fistula or recto-perineal fistula complicated by rectal dilatation are more susceptible to post-operative
constipation. Resection of the dilated rectum at the same time can reduce the incidence rate of constipation. A barium enema should be performed
pre-operatively for patients with congenital recto-vestibular fistula or recto-perineal fistula. If the dilated rectum is found, it can be resected at the
same time.
