Intraoperative Sonographic Guided Pull-through Anorectoplasty: A Novel Procedure for Imperforate Anus and Rectourethral Fistula: A Clinical Trial Study

Background: Optimal surgical management of the neonate with imperforate anus (IA) depends on determining accurate location of sphincter muscle complex, pouch of rectum and rectourinary fistula. We aimed to investigate a novel minimally invasive technique of anorectoplasty assisted by intraoperative sonography pull-through for repair of anorectal malformation and rectourinary fistula. Materials and Methods: Eight male patients with anorectal malformation and IA underwent formation of a diverting colostomy within 48 hours after birth. These patients had anorectoplasty about 6-8 weeks postoperatively. A urinary catheter was inserted per urethra into the bladder and sonography of perineum was carried out under general anesthesia. The neoanus was reconstructed by suturing the pulled-through anorectum to the anal sphincter muscle complex and the skin using absorbable 4/0 sutures. Results: In all cases, the distance of pouch of rectum to the skin was 15-18 mm and entrance of the guide wire to fistula was 6-7 mm. Of eight patients 6 had removal of urinary catheter after two days, and 2 patients after 10 days because the fistula was not closed. The median range of hospital stay was 2.12 days and follow-up was 30 days. We calibrate all of patients with size 12F dilators. Patients were followed up at one week and one month postoperatively, and all had defecation frequency of 3-5 times a day. There were no complications. Conclusion Intra-operative sonography guided pulled-through anorectoplasty (ISPA) is a novel and safe technique for surgical treatment of IA and rectourethral fistula. ISPA is a minimally invasive approach, which preserves the external anal sphincter muscle complex with good functional outcome.