Single-Stage versus Three-Stage Repair in Anorectal Malformations with Rectovestibular Fistula: A Prospective Observational Study

Authors

  • Kashyap Pandya
  • Rajesh Patolia
  • Ananyaa Pandya
  • Bemat Gulamhusen Mohammed

Keywords:

Rectovestibular fistula, Single-stage repair, Three-stage repair, Fecal continence, Pediatric surgery

Abstract

Background: Rectovestibular fistula is the most common subtype of anorectal malformation in females. While the traditional three-stage repair remains the standard in many settings, single-stage repair is increasingly considered as a viable alternative in selected patients.

Objective: To compare the short-term complications, long-term functional outcomes, and hospital stay between single-stage and three-stage repair in female patients with rectovestibular fistula.

Methods: This prospective observational study included 30 female patients treated at KGP Children Hospital, Vadodara, between January 2015 and December 2024. Ten patients underwent single-stage repair, while twenty underwent traditional three-stage repair. Outcomes assessed included postoperative complications (wound infection, anal stenosis, perineal excoriation), fecal continence, constipation, and total hospital stay. Statistical comparisons were made using chi-square and t-tests.

Results: Wound infection was more frequent in the single-stage group (40%) than in the three-stage group (5%). Good fecal continence was achieved in 70% of single-stage patients versus 55% in the three-stage group. Severe constipation was more prevalent in the three-stage group (35%). Mean hospital stay was significantly shorter in the single-stage group (4.8 ± 1.03 days) compared to the three-stage group (11.85 ± 1.81 days, p< 0.001).

Conclusion: Single-stage repair for rectovestibular fistula offers comparable functional outcomes to the three-stage approach and significantly reduces hospitalization time. With proper case selection, it may be a safe and cost-effective alternative in resource-limited settings.

Downloads

Download data is not yet available.

References

Short, S. S., et al. (2018). J PediatrSurg, 53(11), 2174–2177.

Lauriti, G., et al. (2019). PediatrSurg Int, 35, 77–85.

Peña, A. (1988). PediatrSurg Int, 3, 94–104.

Osifo, O. D., et al. (2014). Niger J Clin Pract, 17(1), 1–5.

Amanollahi, O., &Ketabchian, S. (2016). Afr J PaediatrSurg, 13(1), 20–25.

Kumar, B., et al. (2008). J PediatrSurg, 43(10), 1848–1852.

Khalifa, M., et al. (2017). Afr J PaediatrSurg, 14(2), 27–31.

Loulah, M. A., et al. (2015). Menoufia Med J, 28(4), 813–817.

Gangopadhyay, A. N., & Pandey, V. (2015). J Indian Assoc PediatrSurg, 20(1), 10–15.

Peña, A. (1988). Posterior sagittal anorectoplasty: results in the management of 332 cases of anorectal malformations. Pediatric Surgery International, 3, 94–104.

Lauriti, G., et al. (2019). One-stage repair of anorectal malformations in females with vestibular fistula: a systematic review and meta-analysis. Pediatric Surgery International, 35, 77–85.

Khalifa, M., et al. (2017). One or two stages procedure for repair of rectovestibular fistula: which is safer? African Journal of Paediatric Surgery, 14(2), 27–31.

Loulah, M. A., et al. (2015). Primary versus multistage repair of congenital rectovestibular fistula. Menoufia Medical Journal, 28(4), 813–817.

Goyal, A., et al. (2006). Functional outcome and quality of life in anorectal malformations. Journal of Pediatric Surgery, 41(2), 318–322.

Divarci, E., & Ergun, O. (2020). General complications after surgery for anorectal malformations. Pediatric Surgery International, 36(4), 431–445.

Menon, P., & Rao, K. L. N. (2007). Primary anorectoplasty in females with common anorectal malformations without colostomy. Journal of Pediatric Surgery, 42(6), 1103–1106.

Xu, T. O., et al. (2025). The PPP-Perineal Body Preserving PSARP for Anorectal Malformation with Rectovestibular Fistula in Females—Report of Early Outcomes. European Journal of Pediatric Surgery, 35(02), 135–140.

Amanollahi, O., &Ketabchian, S. (2016). One-stage vs. three-stage repair in anorectal malformation with rectovestibular fistula. African Journal of Paediatric Surgery, 13(1), 20–25.

Gad, M., et al. (2022). Comparative study between one-stage versus three-stage repair of anorectal malformation with recto-vestibular fistula. Annals of Pediatric Surgery, 18(1).

Downloads

Published

2025-05-22

How to Cite

1.
Pandya K, Patolia R, Pandya A, Mohammed BG. Single-Stage versus Three-Stage Repair in Anorectal Malformations with Rectovestibular Fistula: A Prospective Observational Study. J Neonatal Surg [Internet]. 2025May22 [cited 2025Oct.24];14(26S):434-40. Available from: https://www.jneonatalsurg.com/index.php/jns/article/view/6306

Issue

Vol. 14 No. 26S (2025): Journal of Neonatal Surgery

Section

Original Article

License

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

You are free to:

  • Adapt — remix, transform, and build upon the material for any purpose, even commercially.

Terms:

  • Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
  • No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.