Single vs. staged PSARP for rectovestibular fistula: a 25-year study on complications, continence, and quality of life

Abstract

Purpose: This study evaluates and compares surgical complications, functional outcomes, and quality of life between single-stage and staged posterior sagittal anorectoplasty (PSARP) procedures in female patients with Rectovestibular fistula (RVF) over a 25-year period.

Methods: A retrospective cohort study was conducted on 54 female patients with RVF treated between 1999 and 2024. Patients were categorized into Group 1 (n = 42, single-stage PSARP) and Group 2 (n = 12, staged PSARP). Demographics, associated anomalies, postoperative complications, Krickenbeck continence scores, and Pediatric Quality of Life Inventory (PedsQL) scores were analyzed and compared.

Results: Group 1 showed significantly higher rates of surgical site infection (22.2% vs. 8.3%, p = 0.01), wound dehiscence (17.8% vs. 8.3%, p = 0.03), and mucosal prolapse (13.3% vs. 0%, p = 0.001). Conversely, anal stenosis occurred only in Group 2 (16.7%, p = 0.001). Voluntary bowel movements (88% vs. 83%, p = 0.86) and reoperation rates (8.9% vs. 8.3%, p = 0.88) were similar across groups. Longitudinal analysis revealed progressive improvement in bowel control and quality of life with age, irrespective of surgical method. PedsQL scores increased from 73.4 in early childhood to 85.5 in adulthood.

Conclusion: Both single-stage and staged PSARP are effective in achieving long-term continence in RVF patients. While the single-stage approach carries higher early wound-related risks, it remains a viable option for well-selected, low-risk patients. Staged repair may be more appropriate for high-risk cases to reduce early complications. Individualized surgical planning and long-term follow-up are essential to optimize functional and psychosocial outcomes.

Keywords: Anorectal malformation; Continence; Posterior sagittal anorectoplasty; Quality of life; Rectovestibular fistula; Single-stage surgery.