Perineal body–sparing transsphincteric anorectoplasty (TSARP) for rectovestibular fistula: Mid-term functional outcomes from a single center

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Demirel B. D., Dağdemir Ezber B., Yağız B.

Pediatric Surgery International, vol.42, no.1, 2026 (SCI-Expanded, Scopus)

  • Publication Type: Article / Article
  • Volume: 42 Issue: 1
  • Publication Date: 2026
  • Doi Number: 10.1007/s00383-026-06485-5
  • Journal Name: Pediatric Surgery International
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, CINAHL, EMBASE, MEDLINE, Academic Search Ultimate (EBSCO), Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest)
  • Keywords: Anorectal malformation, Rectovestibular fistula, Sphincter sparing, Transsphincteric anorectoplasty
  • Open Archive Collection: AVESIS Open Access Collection
  • Ondokuz Mayıs University Affiliated: Yes

Abstract

Purpose: This study aimed to evaluate the mid-term functional and cosmetic outcomes of perineal body–sparing trans-sphincteric anorectoplasty (TSARP) in patients with anal atresia and rectovestibular fistula. Methods: Patients with anal atresia and rectovestibular fistula who underwent perineal body–sparing TSARP between 2018 and 2024 were retrospectively reviewed. All procedures were performed by a single pediatric surgeon. Demographic data, presence of colostomy, perioperative complications, postoperative first-feeding time, and functional outcomes were recorded. Functional outcomes in patients were assessed using the Krickenbeck classification. Results: Twenty-six patients underwent perineal body–sparing TSARP. One-stage repair was performed in 16 patients (61.5%), whereas 10 (38.5%) had a protective colostomy. The median age at operation was 40 days (range 2 days–7 months). Posterior vaginal wall injury occurred in two patients and was repaired uneventfully. Two patients developed wound infection that resolved with local wound care. The mean follow-up duration was 3.25 years. Among 18 patients older than 3 years old, voluntary bowel control was present in 15 patients (83.3%). Constipation occurred in seven patients, and no patient developed soiling. Conclusion: Perineal body–sparing TSARP appears to be a safe and effective technique for rectovestibular fistula, providing low complication rates with satisfactory functional and cosmetic outcomes.