Giuseppe Lauriti1,2,3, Dacia Di Renzo4,5, Pierluigi Lelli Chiesa4,5, Augusto Zani6, Agostino Pierro6. 1. Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada. giuseppe.lauriti@gmail.com. 2. Department of Pediatric Surgery, "Spirito Santo" Hospital of Pescara, Pescara, Italy. giuseppe.lauriti@gmail.com. 3. "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy. giuseppe.lauriti@gmail.com. 4. Department of Pediatric Surgery, "Spirito Santo" Hospital of Pescara, Pescara, Italy. 5. "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy. 6. Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
Abstract
PURPOSE: Females with recto-vestibular fistula (RVF) can be managed either by one-stage sagittal anorectoplasty (SARP) or by conventional multi-stage approach with colostomy followed by SARP. Our aim was to define which approach, one-stage or multi-stage, is safer and more beneficial. METHODS: Using a defined search strategy, two investigators identified all comparative studies on the mentioned procedures. The study was conducted under PRISMA guidelines. The meta-analysis was performed using RevMan 5.3. Data are mean ± SD. RESULTS: Of 649 titles/abstracts screened, 13 full-text articles were analyzed. Three studies were included (156 females). One-stage SARP was associated with increased risk of wound infection (24.3 ± 8.7%) compared to multi-stage approach (10.9 ± 2.5%; p < 0.01) and increased risk of wound dehiscence (16.2 ± 4.8% vs. 2.4 ± 1.1%, respectively; p < 0.01). The incidence of anorectal stenosis was higher following one-stage repair (33.3%) vs. multi-stage approach (10.7%; p < 0.05). No differences were found with regards to redo SARP in both groups (12.9 ± 7.3% vs. 4.8 ± 0.8%; p = ns). At follow-up, the prevalence of soiling and constipation were similar after one-stage (19.7 ± 10.3% and 29.5 ± 5.4%) and multi-stage repair (13.7 ± 8.9% and 28.7 ± 4.4%; p = ns). CONCLUSIONS: In females with RVF, the SARP performed without protective colostomy increases the risk of postoperative complications. However, this one-stage approach seems not to be associated with reduced fecal continence.
PURPOSE: Females with recto-vestibular fistula (RVF) can be managed either by one-stage sagittal anorectoplasty (SARP) or by conventional multi-stage approach with colostomy followed by SARP. Our aim was to define which approach, one-stage or multi-stage, is safer and more beneficial. METHODS: Using a defined search strategy, two investigators identified all comparative studies on the mentioned procedures. The study was conducted under PRISMA guidelines. The meta-analysis was performed using RevMan 5.3. Data are mean ± SD. RESULTS: Of 649 titles/abstracts screened, 13 full-text articles were analyzed. Three studies were included (156 females). One-stage SARP was associated with increased risk of wound infection (24.3 ± 8.7%) compared to multi-stage approach (10.9 ± 2.5%; p < 0.01) and increased risk of wound dehiscence (16.2 ± 4.8% vs. 2.4 ± 1.1%, respectively; p < 0.01). The incidence of anorectal stenosis was higher following one-stage repair (33.3%) vs. multi-stage approach (10.7%; p < 0.05). No differences were found with regards to redo SARP in both groups (12.9 ± 7.3% vs. 4.8 ± 0.8%; p = ns). At follow-up, the prevalence of soiling and constipation were similar after one-stage (19.7 ± 10.3% and 29.5 ± 5.4%) and multi-stage repair (13.7 ± 8.9% and 28.7 ± 4.4%; p = ns). CONCLUSIONS: In females with RVF, the SARP performed without protective colostomy increases the risk of postoperative complications. However, this one-stage approach seems not to be associated with reduced fecal continence.
Authors: H J J van der Steeg; E Schmiedeke; P Bagolan; P Broens; B Demirogullari; A Garcia-Vazquez; S Grasshoff-Derr; M Lacher; E Leva; I Makedonsky; C E J Sloots; N Schwarzer; D Aminoff; M Schipper; E Jenetzky; I A L M van Rooij; S Giuliani; C Crétolle; S Holland Cunz; P Midrio; I de Blaauw Journal: Tech Coloproctol Date: 2015-01-22 Impact factor: 3.781