Anorectal Surgery Techniques for Vestibular Fistula patients: A Review with Highlight on Perineal Body Saving Approach

Sayed, Ahmed Kamal; Moustafa, Alaa AE; Ahmed, Ahmed Hossney; Fathy, Mohamed

doi:10.21608/mjmr.2024.303482.1744

Anorectal Surgery Techniques for Vestibular Fistula patients: A Review with Highlight on Perineal Body Saving Approach

Articles in Press

Document Type : Review Article

Authors

¹ Pediatric Surgery Unit, Faculty of Medicine, Minia University, Egypt

² Pediatric Surgery Unit, Minia University Hospitals, Minia University, Egypt

³ Pediatric surgery, Faculty of Medicine, Minia University, Egypt

10.21608/mjmr.2024.303482.1744

Abstract

Background: Vestibular fistula is a congenital anorectal malformation (ARM) requiring intricate surgical intervention. This review comprehensively examines various anorectal surgery techniques employed in the treatment of vestibular fistula including; Posterior sagittal Anorectoplasty (PSARP), Anterior Sagittal Anorectoplasty (ASARP), Laparoscopic-assisted Anorectoplasty (LAARP), Sphincter Saving Anorectoplasty (SSARP), and Perineal Body Saving Anorectoplasty (PBARP).

Methods: By analyzing existing literature, we compare traditional and contemporary methods, evaluating their outcomes in terms of surgical steps, complication rates, and long-term prognosis. The PBARP is highlighted due to its potential benefits in preserving anatomical integrity and enhancing postoperative quality of life.

Results: Comparing the five techniques for treating vestibular fistula reveals distinct strengths and challenges for each approach. PSARP is renowned for its precise anatomical correction, though it risks damage to the perineal body. ASARP offers a less invasive route by approaching from the anterior side, which can be advantageous in certain anatomical configurations, yet it may not provide the same level of visualization as PSARP. LAARP utilizes minimally invasive techniques, reducing postoperative pain and scarring, but it requires significant surgical expertise and technology. SSARP focuses on preserving the sphincter complex to enhance continence, but the technique can be technically demanding and may still affect the perineal structures. PBSARP is designed to conserve the perineal body, thereby potentially reducing morbidity and enhancing long-term quality of life.

Conclusion: PPSARP is relatively new and requires further validation through comparative studies. Each method's suitability depends on the patient's specific anatomical and clinical needs, making individualized surgical planning essential for optimal outcomes.

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