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Oral Presentation - 25
Is Neonatal PSARP Better Than Traditional Three Stages for Low Sitting ARM?
E Raboei, A Ghallab, A Alsaggaf, M Zidan, A Zeinelabdeen, Y Owiwi, R Luoma
King Fahd Armed Forces Hospital, Jeddah, KSA
Background: Neonatal PSARP without a colostomy is a good option due to minimal trauma and avoidance of potential morbidities of colostomy. Although primary repair of perineal and vestibular fistula without colostomy are done by most of pediatric surgeons around 6 months of age after dilatation and bowel preparation. TPN is given to all patients plus fasting for one week postoperative. We adopted neonatal repair within 48 hours of life for perineal and vestibular fistula without colostomy with early feeding since 1993. To our knowledge this is the longest > 24 years follow up result of functional outcome of neonatal PSARP to be published.
AIM: To evaluate the functional outcome of PSARP without colostomy in newborn for vestibular and perineal fistulas over 24 years.
MATERIAL AND METHODS: A retrospective study for all neonates who underwent PSARP for vestibular and perineal fistulas without colostomy in the 48 hours of life at our institute from January 1993 to January, 2006. No bowel preparation nor parenteral nutrition were needed. We usually commence oral feeding on first post operative day. All patients underwent PSARP as described by Pena. The “neo-anus” was gently dilated on the third week post operatively. Follow up was obtained by a combination of retrospective chart review, clinic review and personal telephone communication. All patients were asked for bowel function notably presence of voluntary and involuntary bowel movement and the presence or absence of both constipation and soiling. Follow-up period ranged from 11-25 years.
RESULTS: a total of 16 newborns with vestibular and perineal fistulas had their repair completed in newborn without colostomy from 1993 to 2006. Nine were girls (56%). 1/16 (7%) had colostomy which was performed later on because of wound dehiscence. All patients are continent. Data's recorded wound dehiscence, stricture formation and constipation in one patient .
CONCLUSIONS: We believe that newborn repair and early initiation of bowel function of the new rectum have better functional results than traditional three stages repair if done by experienced surgeon with supportive ancillary services.