Outcome of patients after single-stage repair of perineal fistula without colostomy according to the Krickenbeck classification

• Published in: Journal of pediatric surgery 2014-08, Vol.49 (8), p.1237-1241
• Main Authors: Chan, Kin Wai Edwin, Lee, Kim Hung, Wong, Hei Yi Vicky, Tsui, Siu Yan Bess, Wong, Yuen Shan, Pang, Kit Yi Kristine, Mou, Jennifer Wai Cheung, Tam, Yuk Him
• Format: Article
• Language: English
• Subjects: Anorectal malformation; Child; Child, Preschool; Colostomy; Female; Fistula - classification; Fistula - surgery; Follow-Up Studies; Humans; Krickenbeck; Male; Pediatrics; Perineal fistula; Perineum - abnormalities; Reconstructive Surgical Procedures - methods; Retrospective Studies; Single stage repair; Surgery; Treatment Outcome
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2013.11.054

Abstract Purpose The aim of the study is to assess the characteristics and outcome of anorectal malformation (ARM) patients who underwent single-stage repair of perineal fistula without colostomy according to the Krickenbeck classification. Methods From 2002 to 2013, twenty-eight males and four females with perineal fistula who underwent single-stage repair without colostomy in our institute were included in this study. Patients with perineal fistula who underwent staged repair were excluded. Demographics, associated anomalies, and operative complications were recorded. The type of surgical procedures and functional outcome were assessed using the Krickenbeck classification. Results Six patients had associated anomalies, including two patients with renal, two with cardiac, one with vertebral, and one with limb abnormalities. Thirteen patients underwent perineal operation, and fourteen patients underwent anterior sagittal approach in the neonatal period. One patient underwent anterior sagittal approach, and four patients underwent PSARP beyond the neonatal period. One patient had an intra-operative urethral injury and one a vaginal injury. Complications were not associated with the type of surgical procedure ( p = 0.345). All perineal wounds healed without infection. By using the Krickenbeck assessment score, all sixteen children older than five years of age had voluntary control. One patient had grade 1 soiling, and no patient had constipation. Conclusions Single-stage operation without colostomy was safe with good outcomes in patients with perineal fistula. The use of Krickenbeck classification allows standardization in assessment on the surgical approach and on functional outcome in ARM patients.