A follow-up study on postoperative function after a modified semi-posterior sagittal one-stage anorectoplasty for female imperforate anus with a rectovesibula fistula

Objective: We evaluated the clinical efficacy of a one-stage modified semi-posterior sagittal anorectoplasty (modified Peña procedure) for radical treatment of female imperforate anus with a rectovesibula fistula. Methods: A total of 89 female neonates who had imperforate anus with a rectovesibula fistula and underwent treatment in our hospital between January 2003 and December 2013 were enrolled in this study, including 39 who underwent the modified Peña procedure (modified Peña procedure group), namely keeping the levator ani muscle and ischiorectal muscle complex intact, and 50 who underwent transperineal anal transposition (transperineal anal transposition group). Postoperative bowel movements were assessed and compared using the Krickenbeck classification and anorectal manometry at follow-up. Results: A significantly lower age at operation and incidence of preoperative rectal dilation was observed in the modified Peña procedure group than in the transperineal anal transposition group (P<0.001). A higher incidence of postoperative soiling was observed in the transperineal anal transposition group compared with the modified Peña procedure group (P=0.049). There was no significant difference in the incidence of grade I postoperative constipation between groups (P>0.05), while a significantly higher incidence of grade II and III postoperative constipation was found in the transperineal anal transposition group (P=0.049 and 0.026, respectively). Anorectal manometry at the 12 month postoperative follow up visit revealed no induction of the rectoanal inhibitory reflex in either group; there were also no significant differences in the resting rectal pressure or active systolic blood pressure between groups. A lower rectal compliance was observed in the transperineal anal transposition group compared with the modified Peña procedure group, although this finding was not statistically significant (P>0.05). Conclusions: The one-stage modified Peña procedure for congenital imperforate anus with a rectovesibula fistula may be associated with a good long-term ability to control postoperative bowel movements.