Risk factors for wound dehiscence after limited posterior sagittal anorectoplasty in female patients with low and intermediate anorectal anomalies

Abstract

The posterior sagittal anorectoplasty, devised by Peña and deVries, has revolutionized the management of anorectal anomalies by providing complete exposure of the anatomy of the anorectal region during surgery. This is the most widely used method and provides exact visualization of the fistula between the rectum and the female genital tract and place the rectum within the confines of the striated muscle complex giving best chance to achieve continence. Perineal infection followed by dehiscence of the anal anastomoses and recurrence of the fistula provokes severe fibrosis, which may interfere with the sphincteric mechanism. In such a case, the patient may have lost the best opportunity for an optimal functional result, because secondary operations do not render the same good prognosis as successful primary operations. The aim of this study was to identify the risk factors for complete wound dehiscence after sagittal anorectoplasty (PSARP or ASARP) in female patients with low and intermediate anorectal anomalies in Ain ShamsUniversity hospitals. To do this we started a case control study, we compare group of patients with postoperative major wound dehiscence with retraction of the neoanus (case group) with patients with no postoperative wound dehiscence or partial wound dehiscence without retraction of the anus (control group). The most important risk factor for major wound dehiscence was the incomplete mobilization of the rectum. Protective colostomy decreased the incidence of partial wound dehiscence(which was managed conservatively), but did not decrease the incidence of major wound dehiscence. Age of the patients, type of ARM, degree of dilatation of the colon and occurrence of vaginal or rectal injury, had a minorrole in the incidence of major wound dehiscence. The incidence of major wound dehiscence and the rate of creation of post-operative colostomy will dramatically decrease,if proper mobilization of the rectumis done for all cases of perineal and vestibular fistulae.