Management and Outcome of Vestibular Anus in Sudan

In female children, the most prevalent types of anomalies are vestibular fistula and ectopic anus. Despite advancements in anatomy, physiology, and embryology (3), surgical challenges remain regarding post-operative cosmetic results and continence outcomes.

Anorectal malformations, which are birth defects characterized by the absence or deformity of the anus, occur equally in both males and females, with an incidence of 1 in 5000 births. ARMs encompass a spectrum of congenital anomalies ranging from minor lesions to complex defects. Different surgeons may use varying terminologies to describe the types of ARMs. The reality is that there exists a broad spectrum of defects, making any classification attempt somewhat arbitrary and imprecise. The traditional classification into 'high', 'intermediate', and 'low' defects often leads to ambiguous or uncertain results. However, studies indicate that a low version is present 90% of the time in females and 50% of the time in males. Typically, ARM necessitates immediate surgical intervention to create a passage for feces, unless a fistula is available or until corrective surgery can be performed. Treatment varies based on the severity of the anomaly, with options including perineal anoplasty alone or a two-stage approach involving colostomy followed by definitive repair (1).

The most frequently observed anomaly in newborn girls is rectovestibular fistula. A perineal examination typically reveals a normal urethra, a normal vagina, and an additional opening behind the vaginal orifice, which is the rectal fistula located in the vestibule. For newborns exhibiting clinical signs of a rectovestibular fistula, a diverting colostomy is considered the safest approach for surgeons lacking extensive experience with anorectal anomalies. While performing a colostomy prior to the main repair helps prevent infection complications, the creation of a colostomy in neonates must be approached with caution.