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EPN 2021

Muhammad Riaz ul Haq

Muhammad Riaz ul Haq, Speaker at Neonatal Conferences
Sahiwal Medical College and Sahiwal Teaching Hospital, Sahiwal, Pakistan
Title : Single stage sphincter sparing scarless (5s) procedure for rectovestibular fistula: Outcome and review of literature



Anorectal malformations (ARM) in girls comprise of  a wide spectrum of disease ranging from imperforate anus to common cloaca, a complex malformation. Recto-vestibular fistula (RVF) is the commonest ARM in female patients. Many surgical procedures have been mentioned in the literature but trend is changing from staged to single stage procedure.

Objectives: To evaluate post operative results of Single Stage  Sphincter Sparing Scarless (5S) procedure for RVF.

Methods: It is a retrospective case series of 34 patients with RVF who were admitted in the Department of Paediatric Surgery Jinnah Hospital Lahore and the Children Hospital and  the Institute of Child Health Multan Pakistan from October 2018 to December 2020, between 14 days and 4 years of age , underwent single stage sphincter sparing scarless procedure without any colostomy, anterior or posterior midline incision or division of sphincteric complex. Site of neo-anus was marked with the help of muscle stimulator and all surgeries were done under general anesthesia after meticulous gut preparation. Post operatively patients were kept nil per oral for 5 days to avoid wound contamination due to stool. Follow up was done for six months to evaluate outcome. Authors used a new name for single stage procedure.

Results: Mean age was 168 days, operative time 76 minutes and hospital stay 6.8 days. 12 (35.29%) patients were diagnosed with some other associated congenital anomalies like congenital heart disease (CHD), renal anomalies, hemisacrum, syndactyly, talipes equino varus(TEV) and Down’s syndrome. As a whole 16(34) presented with complication. 7(20.58%) patients presented with constipation, 4(11.76%) excoriation, 3(10.20%) anal stenosis, 3(10.20%) soiling, 1(2.94%) retraction of rectum and 3(10.20%) superficial wound infection. Patient with retraction was planned for re-do surgery, all others were managed conservatively.

Conclusion: Single stage sphincter sparing scarless ( 5S) procedure for recto-vestibular fistula is safe, simple and cost effective technique. Patient suffering is minimum, as there is no colostomy, and multiple surgeries. Complications are minimum and comparable to staged procedure.

Literature review will be done for different surgical techniques used for repair of Rectovestibular Fistula and Author’s own experience will be shared

Key words: Imperforate anus, rectovestibular fistula, anorectal malformation, female, sphincter sparing.


Dr.Muhammad Riaz-ul-Haq did his Fellowshp( FCPS) in the subject of Paed.Surgery in 2001 from College of Physicians and Surgeons Pakistan, Fellowship of European Board in paed.surgery in 2008 (UK), visiting fellowship from Nationwide Children Hospital Columbus Ohio (2008) and was honored by American College of Surgeons by FACS. He worked in Pakistan and Saudi Arabia in different teaching hospitals as a consultant. At present he is working as Associate Professor and Head of Paed.Surgery Department in Sahiwal Medical College Sahiwal, Pakistan. He has many research papers in national and international journals. His special interest in Neonatal surgery, hypospadias, Anorectal malformations and Hirschsprungs disease.