Background: Vestibular fistula is one of the most common types of anorectal malformations in female infants. Colostomy prior to definitive anorectoplasty is still controversial.

Objective: To compare the complication rates and functional outcomes of the surgical treatments of vestibular anus between colostomy prior to anorectoplasty and treatment without colostomy.

Materials and Methods: The medical records of 40 patients with vestibular fistula that underwent definitive surgical treatments at Siriraj Hospital between January 2006 and December 2018 were reviewed. Demographic data, operative records, functional outcomes, and complications were analyzed.

Results: In the 40 vestibular fistula patients, colostomy (C) prior to vestibular fistula repair was performed in 18 patients, while vestibular fistula was repaired without colostomy (NC) in the other 22 patients. The C group had more associated anomalies than the NC group, including GI tract anomalies at 23.5% versus 9.1%, spinal anomalies at 47.1% versus 9.1%, and KUB anomalies at 52.9% versus 9.1%. The definitive anorectoplasty for vestibular fistula were anal transposition (31, 77.5%), PSARP (5, 12.5%), and other operations (7, 10%). Anal transpositions were performed in both the NC (90.9%) and C (61.1%) groups, respectively. NC had higher complications than C at 36.4% versus 22.2%. The recurrence of fistula occurred in 9.1% of NC cases versus 0% in C. Anal stricture was found in 18.2% of NC cases versus 5.6% in C. The wound infection rates of these two groups were the same. The complication rate with colostomy was 22.2% with prolapsed colostomy in 11.1% of cases and wound infection in 5.6%. The NC group had higher complication rates of anorectoplasty than the C group, but the overall complications, including colostomy complications, of these two groups were comparable. The Krickenbeck scoring system was used to evaluate the functional outcomes. In the median follow-up period of 1,336 days and 23 patients were evaluated. Even though the NC group had higher complication rates of anorectoplasty than the C group, the functional outcomes of these two groups were the same.

Conclusion: Vestibular fistula repair with prior colostomy had lower complication rates of anorectoplasty than primary vestibular fistula repair, but the functional outcomes of these two groups were the same.

Keywords: Vestibular; Rectovestibular; Anovestibular

DOI: 10.35755/jmedassocthai.2022.03.11520

Received 15 June 2020 | Revised 4 February 2022 | Accepted 7 February 2022